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Department of faculty and hospital surgery
Tashkent Medical Academy
Diseases of the
esophagus
Diseases of the esophagus
Occupies the 6th place
In the structure of human
diseases
On the 3rd place
Among diseases of
gastro - intestinal
tract (after disease
Of stomach and rectum)
The incidence rates of esophageal
population in 2010 year
(100 thousand)
Incidence of malignant tumors
In 2010 year in the Republic of Uzbekistan
History of surgical treatment
of esophageal-is starting with
1877., When Vincenz Cherny
conducted the first successful
resection of the cervical
esophagus
Vincenz Czerny
(1842 − 1916)
Franz J. A. Torek
(1861-1938)
Only in 1913, Franz Torek
first successfully performed
transtorakaling resection of
the esophagus (through
the left torakotomtion
access) cancer middle
chest
Transthoracic access to the clinic
tried to apply Johannes von Mikulicz
(1904), Ernst Sauerbruch (1905),
but these attempts were
unsuccessful
Johannes von Mikulicz-Radecki
1850 - 1905
Sergey Yudin
(1891-1954)
Peter A. Herzen
(1871-1947)
Ivan Greeks
(1867-1934)
Mikhail Davydov
Vasit Vakhidovich
Vahidov
Shavkat Ibrahimovic
Karimov
Sadik Aliyevich
Masumov
Nikolai Fedorovich Krotov
Duties of the general practitioner in diseases of the
esophagus
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- Provision of primary health and social care;
- Health education (promoting healthy lifestyles);
- Preventive work (timely detection of early and latent forms of the
disease, risk groups);
- Dynamic monitoring;
- Emergency assistance in case of emergency and acute conditions;
- Timely consultation and hospitalization in the prescribed manner;
- Medical and rehabilitation work in accordance with the qualifying
characteristic;
- An examination of temporary disability;
- The organization of medical and social care and household together
with the bodies of social protection and services of mercy alone, the
elderly, the disabled, the chronically ill;
- Maintaining the approved forms of records and reports.
Anatomy of the esophagus
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Tracheal
Aortic
Bronchial
Aorto-bronchial
Epibronhial
Retropericardial
Supradiaphragmatic
Intradiafragmal
Abdominal
Anatomical region and part of the esophagus
1. The cervical
2. Hilar department
a. The upper part of the
chest
b. The average breast
part.
c. The lower part of the
chest (including
abdominal
esophagus).
Blood circulation and the lymphatic system
of the esophagus
branches of the lower
thyroid artery
bronchial
artery
branches of the thoracic
aortic
ascending branch
left gastric
artery
Metastasis
Methods of study of the
esophagus
1.
2.
3.
4.
5.
6.
Radiographs
Endoscopic examination
Radioisotope study (external and
intraluminal)
Ultrasound examination
Intraesophageal pH-meters
The study of motor
Endoscopic method of
investigation of the esophagus
X-ray method for studying the
esophagus
Classification of diseases of the esophagus
I. Malformations
1 Congenital esophageal atresia and esophageal-tracheal fistula
2 Congenital stenosis of the esophagus
3 Congenital diaphragm membrane of the esophagus
4 Congenital short esophagus
5 Congenital esophageal cyst
6 Anomalies vessels
II. damage
1 Traumatic injuries - interior and exterior
2 Burns of the esophagus and their consequences
III. diseases of the esophagus
1 diverticula - pulse and traction
2 Inflammatory diseases - esophagitis
IV. Tumors of the esophagus
1 Benign tumors
2 Cancers
V. Violation of esophageal motility (cardiospasm)
1 Achalasia
2 esophagism
The frequency of lesions of the
esophagus
Cancer
Sarcoma
Polyps
Cardiospasm
Cicatricial stricture
Diverticula
Esophagitis
Tuberculosis
Syphilis
60-80
0,04
0,04
5,1
0,7
0,6
0,2
0,02
0,08
Esophageal cancer is 3.4% of all malignant neoplasms
Dysphagia
Grade I - pass any food, but swallowing solid food
there are unpleasant sensations (burning, scratching,
sometimes pain)
Grade II - solid food stays in the esophagus and
passes with difficulty, it is necessary to wash down
solid food with water
Grade III - solid food does not pass. When you try to
swallow it arises regurgitation. Patients are fed liquid
and semi-liquid food
Grade IV - the esophagus to pass only liquid
Grade V - complete obstruction of the esophagus.
Patients are unable to swallow a sip of water, does
not pass even the saliva
Types of congenital esophageal atresia
Esophageal
corpus
alienum
Esophagealbronchial
fistula
Excision of the esophagealbronchial fistula
Degree of burns of the
esophagus
Grade I - redness and swelling of
the mucous membrane
Grade II - the defeat of the
mucosa and submucosa
Grade III - the defeat of all the
shells of the esophagus
Factors determining the degree of
damage to the esophagus a burn
1 The nature of the received material
 2 Number of received material
 3 Concentration of the solution
 4 Consistency received substance
 5 Individual sensitivity to the received
substance
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The clinical picture of burns of the
esophagus
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Acute stage (5-10 days), pain in the mouth, pharynx, behind
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Step imaginary well-being (7-30 days) as a result of
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Stage of formation of the stricture (from 2 to 6 months,
sometimes years) on the wall of the esophagus ulcers of
the breastbone, in the epigastric region. Hypersalivation.
dysphagia, shock in the next few hours after the injury. Burn
toxemia after a few hours begins to prevail
rejection of the necrotized esophageal webs around the end of
the 1st week is somewhat looser. Complications: esophageal
bleeding, perforation of the wall of the esophagus, in the
presence of extensive wound surfaces develops sepsis
different sizes. Wound surface covered with a scab, bleed easily.
Dysphagia can reach the degree of complete obstruction of the
esophagus. When top strictures: laryngospasm, coughing,
choking due to spillage of food into the airway
Burns and scar strictures of the
esophagus
Short burn stricture at
pharyngeoesophageal
transition
Short burn
stricture of the
middle third of
the esophagus
Extended burn
stricture of the
esophagus
Burns and scar strictures of the
esophagus
Complications caused by chemical burns of the
esophagus
Early
shock
laryngeal edema
hemolysis
Older
stricture
depletion
pulmonary
Early
acute tracheobronchitis
pneumonia
Esophageal-bronchial fistula
Perforation
mediastinitis
pericarditis
empyema
bleeding
Older
pneumonia
lung abscess
bronchiectasis
Esophageal-bronchial fistula
Other
foreign bodies
diverticula
Hiatal hernia
Cancer of the esophagus
Complications of dilatation
anemia
sepsis
Treatment of burns of the
esophagus in the acute period
1.
2.
3.
4.
5.
6.
7.
8.
9.
Neutralize poison
Removal of intoxication and pain
Normalization of water-salt metabolism
Anti-inflammatory therapy
Parenteral nutrition
Normalization function of the cardiovascular
system
Normalization of renal function
Prevention of respiratory disorders
Oral Care
Probing of the esophagus
Segmental esophagoplasty colon
Esophagoplasty stomach
Esophagoplasty with stomach
Esophageal diverticula
Esophageal diverticula
Esophageal diverticula
Esophageal diverticula
Complications of esophageal
diverticula
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1
2
3
4
5
Diverticulitis - 85.2%
Intestinal obstruction - 6.5%
Bleeding - 4.3%
Perforation or penetration - 3.2%
Tumor development - 0.8%
Removal of esophageal
diverticulum
Classification of reflux esophagitis
I. Primary
Primary disorders of the nervous and peptide
(gastrin, histamine, motilin, etc..) Regulation of
motility of the esophagus and the stomach
II. Secondary
When hiatal hernia, pyloric stenosis, peptic ulcer,
cholecystitis, large tumors in the abdomen, ascites,
pregnancy, after gastrectomy, scleroderma, and
other diseases
III. Severity (endoscopic classification of Savary
and Miller, 1978)
Stages of cardiospasm
(B.V. Petrovsky)
Stage I - unstable functional spasm of the
cardia, the expansion of the esophagus is not
observed
Stage II - stable spasm of the cardia with soft
extension of the esophagus
Stage III - scarring the muscle layers of the
cardia with a pronounced expansion of the
esophagus
Stage IV - pronounced stenosis of the cardia
with dilation of the esophagus, often Sshaped with esophagitis
Cardiospasm
stage IV
stage II
stage III
Treatment of the cardiospasm
Treatment of the cardiospasm
operation of Nissen
Achalasia of the esophagus
The most characteristic symptoms
of achalasia of the esophagus
1.
2.
3.
4.
5.
6.
Dysphagia
After the passage of food techniques that
increase the intraluminal pressure
Regurgitation (a few hours after a meal
the night immediately after a meal)
Pain (pain crises, non-food, pain on
swallowing, paresthesias, itching, etc.)
Nausea, vomiting, weight loss
Complications (esophagitis, the transition
to cancer, respiratory disorders)
A benign tumor of the esophagus
Removal of a benign tumor of the
esophagus
Cancer of the esophagus
The share of esophageal cancer:
structure bowel diseases - 5-7%;
in the structure of all neoplasms of the
body - 1.5-2%.
Mortality from cancer of the esophagus,
in a number of other malignancies,
up - 5-6%.
Factors contributing to the development
of cancer of the esophagus
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Alcohol and tobacco;
Deficiency of vitamin A, riboflavin, zinc, molybdenum;
Dietary carcinogens;
Chemical burns or stricture of the esophagus;
Tyloses (a disease characterized by hyperkeratosis of the
palms and soles);
Plummer-Vinson syndrome (iron deficiency anemia + +
achlorhydria stricture of the upper esophagus;
A long-term untreated achalasia;
Prior exposure of the mediastinum;
Celiac disease and chronic non refluks esophagitis.
Cancer of the middle third of the
esophagus
Cancer lower third of the
esophagus
Growth form of esophageal cancer
Symptoms of esophageal cancer
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General
adynamy, weight loss, fatigue, low-grade fever,
hypoproteinemia
Characteristic of diseases of the chest cavity
blunt chest pain, tachycardia after eating, changing
the tone of voice, coughing
Characteristic of esophageal
Dysphagia - reflex, mechanical or mixed, increased
salivation, pain, bad breath, bad taste, regurgitation
Clinical manifestations of esophageal cancer
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Dysphagia;
Weight loss;
Odynophagia;
Constant chest pain, epigastric and back;
Hiccups;
Hypersalivation;
Hoarseness;
Symptoms of damage to the nervous system and
muscles;
 Vomiting blood.
Diagnosis primary binding studies
 Chest X-ray in 2 projections;
 Polypositional contrast study of the esophagus and
stomach;
 Esophagoscopy with multiple biopsies from both the
tumor and from the mucosal sites are not altered by the
expected resection line;
 Morphological examination of the biopsy specimen;
 Ultrasound imaging of the mediastinum, supraclavicular
areas, abdominal, retroperitoneal, pelvic organs;
 ECG;
 bronchoscopy;
 General analysis of blood and urine tests, biochemical
blood tests, coagulation, immunoassay, blood group and
Rh factor.
Diagnosis additional studies
 Computed tomography of the chest
and abdomen with contrast;
 Diagnostic thoracoscopy;
 Diagnostic laparoscopy -with suspect
the presence of metastases in the
abdominal cavity.
Radiographs of patients with esophageal
cancer
At the level of Th6 determined by
restriction
esophagus. Patency of barium significantly
impeded.
CONCLUSION: Cancer middle third of the
esophagus.
There is a circular narrowing of the esophagus at the level
of TH7, for 3.0-3.5 cm. Above which the esophagus
suprastenoticheski expanded.
CONCLUSION: Cancer between the middle and lower third
of the esophagus (endophytic growth).
Radiographs of patients with esophageal
cancer
Esophagus pass all over. At the level of VTh6Th7 determined luminal narrowing, tuberosity
contours. The length of the process = 7.0-8.0
cm.
CONCLUSION: Cancer middle third of the
esophagus.
From the level of VTh V-VII, for 7.0-8.0 cm.
Celebrated circular narrowing of the esophagus with
irregular contours, the destruction of the mucous
relief.
CONCLUSION: Cancer middle third of the
esophagus.
The differential diagnosis
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Cardiospasm.
Cicatricial narrowing of the esophagus.
Esophageal ulcers and ulcerative esophagitis.
Benign tumors of the esophagus.
Esophageal varices.
Diverticula of the esophagus.
Compression of the esophagus from the outside tumors of the
mediastinum.
 Scars after suffering mediastinitis.
 Abnormally positioned vessels in the mediastinum.
Leading in the differential diagnosis of esophageal cancer is
morphologically !!!
Only multiple negative answer, along with watchful waiting may make
relatively favorable judgment.
Methods of treatment of
esophageal cancer
radiation
Herbal
Surgical
Combined
Complex
Subtotal esophagectomy with intrapleural
simultaneous plasticity with stomach by Lewis.
Operation - one-step, two available.
Access - wide upper midline laparotomy bypassing the navel to the
left, then anterolateral thoracotomy in the IV-V intercostal space on
the right.
Esophagogastroanastomosis in the right pleural cavity.