[Barotraumatic rupture of the esophagus. 4 cases. Review of the literature].

Oesophageal barotraumatism is a rare lesion and only 19 cases have been reported in the literature. Four new cases are described, the mechanism involved being either a jet of gas into the oesophagus or an explosion close to the face producing rupture of the oesophagus by increased endoluminal pressure. Four characteristic clinical signs are noted: wounds or burns to the face or mouth, chest or epigastric pain, subcutaneous emphysema and respiratory distress. A pneumomediastinum or pleural effusion is a constant finding, and a perforation is identified regularly by an oesophageal water soluble opacification. Of the 19 cases reported in the literature, 4 were detected at autopsy, one patient died after surgery and 14 recovered after operation. The mediastinal infection was either subacute requiring external thoracic drainage after oesophageal exclusion, or acute, necessitating emergency direct oesophageal repair. Only one of the 4 patients reported in this paper survived the accident.