Posted in surgery

Most common for Oesophagus

  1. Most common among the oesophageal diverticula is Zenker’s diverticulum.
  2. Most common benign oesophageal tumour is leiomyoma or stromal tumour (GIST).
  3. Most common upper GI disorder of the Western world is gastro-oesophageal reflux disease.
  4. Most common histological type of carcinoma oesophagus in the world is squamous cell carcinoma.
  5. Most common histological type of carcinoma oesophagus among whites is adenocarcinoma.
  6. Most commonly adenocarcinoma affects lower oesophagus. Most common presenting feature of Barrett’s oesophagus is dysphagia.
  7. Most common site of gastrointestinal involvement in scleroderma is smooth muscle of oesophagus.
  8. Most common cause of oesophageal perforation is instrumentation.
  9. Most serious but rare type of perforation is Boerhaave syndrome-barotrauma, seen in gluttons.

© Manipal manual of surgery, fourth edition

Posted in surgery

Investigation of choice

Oesophagus & Diaphragm

  • Investigation of choice for diagnosis with histological proof is endoscopic biopsy. 
  • Investigation of choice to identify haematogenous metastasis is CT scan
  • Investigation of choice to detect tracheal/bronchial involvement is bronchoscopy
  • Investigation of choice to know the depth of invasion is endosonography
  • Investigation of choice to detect enlarged nodes which are malignant or nonmalignant is PET scan. 

© Manipal manual of surgery, fourth edition

Posted in surgery

Clinical note 

A 60-year-old agriculturist was referred to the department of ENT for dysphagia of 3-4 days duration. A Registrar who saw the case did rigid oesophagoscopy under GA. The findings were normal. Later in the evening he was called to see this patient who had rigid abdomen. A general surgeon was consulted. He suspected a perforation. An X-ray abdomen (erect) however, was normal. A senior faculty surgeon was consulted who examined the case properly and gave a correct diagnosis. It was a case of tetanus with mild trismus. The patient had injured his left thumb a few days back. The anaesthesiologist acknowledged later that there was some difficulty in opening the patients mouth during endotracheal intuabtion. 

Occasionally, patients undergo gastroscopy for dysphagia which will be normal only to realise later that what he is having is a stroke! ! l. 

© Manipal manual of surgery, fourth edition,