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Carcinoma of esophagus is the sixth most common cancer in the world. Carcinoma of esophagus is notorious in the sense that it spreads very early and only 25% of the patients are diagnosed at a stage where cure can be achieved. An estimated 80% of primary esophageal neoplasms are malignant. Squamous cell carcinoma and adenocarcinoma are the most common histologic subtypes of esophageal cancer. Both histologic subtypes have very different biological and epidemiologic profiles; consequently, esophageal squamous cell carcinoma and esophageal adenocarcinoma should be viewed as separate disease entities. Squamous cell carcinoma primarily occurs in the middle third of the esophagus, while adenocarcinoma predominantly occurs in the lower third of the esophagus. Squamous cell carcinoma remains the most common histologic subtype of esophageal cancer worldwide. Causes: causative factors are different for adenocarcinoma and squamous cell carcinoma Adenocarcinoma: ( lower 1/3rd) Barrett's esoph...

Accidental caustic injuries occur mainly in children and are usually taken in small quantity while in adults and in teenage caustic ingestion are usually deliberate in an attempt to suicide and taken in heavy amount. Any substance with pH less than 2 or more than 12 leads to caustic damage Caustics and corrosives cause tissue injury by a chemical reaction. The vast majority of caustic chemicals are acidic or alkaline substances that damage tissue by accepting a proton (alkaline substance) or donating a proton (acidic substance) in an aqueous solution Acids are present in battery acids, anti rust compounds and toilet cleaners while Alkalies are present in drain cleaners, washing powders, hair straightness and bleaches Alkalies dissolve the tissue and therefore penetrate more deeply while acids cause coagulative necrosis that limits their penetration. Acids cause more severe damage to the stomach. This typically causes stricture in the pre-pyloric area where the acid pools. With a large ...

  MALLORY WEISS SYNDROME: It is a vertical tear at the cardia caused by forceful vomiting. These tears lie just below the squamocolumnar junction at cardia in 90% cases and in the esophagus in 10% cases. It produces hematemesis and malena. Bleeding is usually mild and endoscopic injection sclerotherapy may\ be needed in occasional cases. Mallory-Weiss tear A Mallory - Weiss tear is a tear in the mucosal layer at the junction esophagus and stomach BOERHAAV'S SYNDROME: It is spontaneous perforation. It is full thickness tear of distal esophagus caused by excessive intraluminal pressure which is produced by forceful vomiting against closed glottis. Almost 300 years ago, Herman Boerhaave, a Dutch physician, described the case of Barron Wassenaer, the Grand Admiral of Holland. In 1724, Boerhaave was called to the bedside of the admiral, who complained of severe chest pain and exclaimed that something had burst in his chest. The admiral had consumed a huge meal, had taken a self-prescrib...

Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. Most common causes of esophageal perforation include Medical instrumentation (65%) Post emetic (16%) is also called Boerhaav's syndrome. Trauma Post-operative Penetrating chest injury Blunt chest trauma  Less common causes Neoplasm  Ingestion of caustic materials Clinical features: Retrosternal chest pain Dyspnea Cough Subcutaneous emphysema Sepsis (fever, leukocytosis,shock) Peritonitis in case of distal esophageal perforation Investigations: Posteroanterior and lateral chest and upright abdominal radiographs (diagnostic in 90% of cases).  Following findings may be noted in case of esophageal perforation Hydrothorax (usually on the left) Hydropneumothorax Pneumothorax Pneumomediastinum Subcutaneous emphysema Subdiaphragmatic air (in case of perforation of intra-abdominal portion of esophagus) Gastrografin or barium contrast study: Treatment: The reported mortality from tre...