In the neck the oesophagus rests on the longus colli muscle and vertebrae behind and has the trachea in front. On the left side it lies close to the carotid sheath, the lobe of the thyroid gland, and the thoracic duct. The left recurrent laryngeal nerve is in closer relation to it than the right on account of the latter coming over from the right subclavian artery. The left nerve lies on its anterior surface near the left edge. The right carotid artery lies farther from it than does the left. The left inferior thyroid artery is also in closer relation to it than the right on account of the inclination of the oesophagus to the left side.

In the thorax it passes through the superior mediastinum between the trachea and its bifurcation in front and the aorta behind.

In front it has the bifurcation of the trachea and encroaches more on the left than on the right bronchus. The arch of the aorta and the left carotid and subclavian arteries also pass in front of it and in the posterior mediastinum the pericardium and diaphragm are anterior to it.

Posteriorly, above it rests on the spinal column, but below the bifurcation of the trachea the aorta intervenes.

Laterally it is in relation with the left pleura above and the right below and the vena azygos major runs along its right side posteriorly. The arch of the aorta winds around its left side at the root of the lung. The right vagus nerve runs down posteriorly and the left anteriorly, forming a plexus on its surface.

Dilatation And Diverticula

In certain rare cases the oesophagus becomes dilated; this may involve the whole length of the tube or only its lower end. Obstruction low down may be a cause. It has been known to accompany a largely dilated aorta which pressed the oesophagus against the diaphragmatic opening and so hindered the passage of food. Regurgitation of food is a prominent symptom and liquids may regurgitate from the stomach and even enter the mouth.

Diverticula are usually acquired and are but seldom congenital. The point of junction with the pharynx just behind the cricoid cartilage is the most frequent seat. A sac is formed which descends posteriorly behind the part of the tube below and as it increases in size it presses forward and may obstruct its lumen. Obstruction from foreign bodies, stricture, or disease of the cardiac end of the stomach may be a cause. Vomiting is a prominent symptom and the vomited material does not show any evidences of digestion or the presence of acid. The existence of a tumor which forms only on deglutition and which can be emptied by pressure is said to be pathognomonic of an oesophageal diverticulum.

Diverticula have been treated by washing out with a stomach-tube, by excision, or if emaciation is rapid and marked by doing a gastrostomy.

Carcinoma And Stricture

Carcinoma is usually of a flat-celled epitheliomatous type and may surround the oesophagus like a ring. The walls are thickened, a tumor forms, and the internal surface may become ulcerated. Stricture of the affected part may lead to the formation of a dilation or diverticulum above, and ulceration and abscess may perforate and enter surrounding organs.

Dyspnoea may arise from pressure on the air-passages and pus may even penetrate them. Hemorrhage is also sometimes a symptom. It may come either from the inside or outside. In the latter case it may come from the large vessels in the neighborhood.

Septic inflammation may also be set up in the adjacent pleura and lungs.