Esophagus

Foreign body esophagus

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Q) True about foreign body in esophagus

a) Sharp objects should be operated and not retrieved

b) Lead batteries should be removed

c) Most common impacted foreign bodies are dentures

d) Contrast examination of esophagus should be done before endoscopy

 

Answer

b

Sharp objects can be removed over overtubes and not always require surgery. Lead batteries can corrode and decay in the stomach or intestine and should always be removed. Most common impacted foreign bodies are food boluses above a pathological narrowing and require endoscopic break up

Contrast examination is not always required and might complicate things

Bailey page 991

Two field esophagectomy

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Q) Which is not included in two field esophagectomy in carcinoma esophagus

a) Supra carinal and cervical

b) Infra carinal and celiac

c) Superior mediastinal

d) d) Posterior mediastinal

Premium members

Discusss the lymph node stations

Japanese and european classifications of esophageal spread

Two field esophagectomy

 

Siewert classification for GE junction tumors

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Q) According to Siewert classification tumors at GE junction are

a) Type I

b) Type II

c) Type III

d) Type IV

Answer b

Type I   Lower  (center located within between 1-5cm above the anatomic OGJ)

Type II Real GE junction  (within 1cm above and 2cm below the OGJ)

Type III  (2-5cm below OGJ)

This classification has only 3 subtypes

According to the Siewert-Stein classification,

Type I tumour 25% approx

Type II - Most common 49%

Type III was present in 25%

This classification helps in deciding the operative management and unified pre op classification

Types of Surgery

Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy  or THE

In patients with types II and III cancers total gastrectomy

More ref 

  1. Radiopedia
  2. Reviews Article

 

Timing after esophagus perforation

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Q) Management of esophagus perforation after 96  hours in a 40 year old patient with pulse 110/min and BP 110/80 Best option

a) Antibiotics and drainage of left pleural effusion

b) Primary repair of esophagus

c) Esophagectomy and gastric pull up

d) Cervical Esophagus diversion 

Questions on Esophagus

Discussion on all treatment modalities and which to use when

 

Esophagus perforation

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Q) A 45 year old man who has been drinking regularly for the past 15 years vomits after a large meal and complains of severe chest pain. Cardiac cause is ruled out and boerhavve's syndrome is suspected. Which of the following is not true about this condition

a) Gastrograffin tests will confirm the diagnosis

b) Perforation is most common in the left lower end

c) Exploration and full thickness suturing of perforation should be done

d) This condition has a high morbidity and mortality if not diagnosed at time

Answer for premium members  - Discussion on Boerhaave's syndrome