Iatrogenic Injury to the Hypopharynx and Cervical Esophagus: An Autopsy Study

Abstract

The occurrence of iatrogenic injury to the adult hypopharynx and cervical esophagus has been casually documented by direct surgical exploration, endoscopy, radiography and, occasionally, by autopsy. To provide meaningful knowledge about the incidence of injury, the nature of the lesions, the character of the offending instruments and those injury-prone patients, a consecutive autopsy series was performed, focusing upon the pathology of the hypopharynx and cervical esophagus. One hundred and forty-nine consecutive hypopharyngeal-cervical esophageal specimens were examined. Sixty-nine percent of the patients had metal instruments or soft, flexible tubing placed through their oral and nasal pharynges. Sixty percent of those instrumented showed injury. All instruments used were found to have caused injury, suction catheters being implicated for the first time. Specific groups were found to be injury-prone, the most susceptible being those with thrombocytopenia. Only two percent of all injuries were noted antimortem.