Oesophagus showing a perforation
GC.8863
Oesophagus and the hypopharynx, laid open posteriorly, with the, larynx and trachea, showing a perforation.
From a female aged 16 years who was said to have swallowed half an ounce of Lysol and, after having had her stomach washed out, appeared none the worse. Three years later she swallowed a small quantity of commercial hydrochloric acid, burning her lips and tongue and causing pain in the mouth throat, and abdomen. The administration of apomorphine induced free and repeated vomiting. No instruments were passed, and she was discharged from hospital on the thirteenth day.
Difficulty in swallowing was experienced immediately thereafter and gradually increased during the following month, when examination by the oesophagoscope showed a narrowing some 2.5 cm, from the oesophageal aditus. By means of bougies the stricture was dilated until a 0.7 cm. bronchoscope tube could be passed without difficulty when, 7.5 cm distally a second stricture was seen through which it was found impossible to pass the smallest bougie. This was followed by symptoms of inflammatory disturbance, and death occurred forty two hours later.
On post mortem examination there was a septic posterior mediastinitis (inflammation of the tissues in the mid-chest), an accumulation of pus in the left pleural cavity, and septic pericarditis. On opening the oesophagus by a posterior mesial incision, a small opening on the left lateral wall 3 cm from the aditus led to a sac formed by the raised mucosa, which extended for 18 cm and ended blindly 2 cm proximal to the diaphragm. On opening the sac longitudinally the cavity was found to contain some of the bismuth which had been administered by the mouth before death. On the anterior oesophageal wall within the sac, opposite the bifurcation of the trachea was a second circular opening which passed distally within the oesophageal wall and ultimately perforated into the posterior mediastinum.
The specimen shows the mucosa has been removed from the left wall of the oesophagus for a considerable distance, and a glass rod is inserted into the lower extremity of the sac and passes distally into the posterior mediastinum.
