It may terminate in a blind pouch in its upper portion; it may be double or completely wanting. Fistulae opening into the pharynx and neck are the result of incomplete closure of the branchial arches.

Circulatory disturbances may be part of a general condition. In diseases of the heart, lungs, and in cirrhosis of the liver passive congestion with varicose veins may be present. Rupture of such veins with severe hemorrhage may take place.

Inflammation of the esophagus, esophagitis, may be the result of irritation of foreign bodies, as hot liquids, acids, and alkalies, or of infection. In the catarrhal type there is hyperemia, infiltration of the mucous coat, and desquamation of epithelium, with occasional ulcer formation. If the process becomes chronic, as in long-continued passive congestion and in alcoholics, the mucous membrane is thickened, and thrown into folds; is dark in color, ulcers are present, and there may be hypertrophy of the muscular coat.

Pseudo-membranous esophagitis may be the result of infection by the streptococcus or by the diphtheria bacillus, or may be caused by swallowing corrosive fluids. It is usually secondary to extension from neighboring tissues that were primarily involved.

Suppurative esophagitis may result from extension of inflammation from the mucosa to the submucous coat, or it may be due to traumatism involving the deeper tissues.

In smallpox ulcers may form as a result of the eruption of pustules and thrush may extend from the mouth.

Stenosis Of The Esophagus

Stenosis Of The Esophagus may be the result of interference from within or from without. Compression by tumors, aneurysms, or other lesions. The most frequent cause is a stricture, which may take place rapidly or slowly depending upon the severity and extent of the ulceration. This usually results from the contraction of cicatrices formed in the healing of ulcers due to the swallowing of destructive liquids, as acids and alkalies. The commonest site for a stricture is at one of the natural narrowings of the esophagus, at the cricoid, tracheal bifurcation, or diaphragm. May be caused by syphilis, a rare occurrence. Carcinoma may cause stenosis by projecting into the lumen or by contracting the walls. May also be due to obstruction by a foreign body.

Dilatation Of The Esophagus

Dilatation Of The Esophagus is the result of an obstruction and usually occurs at the cardiac end, where it passes through the diaphragm into the stomach. Sometimes dilatation occurs without stenosis, in which case the esophagus is in the form of a pouch, largest at its center.

Diverticula Or Local Sacculations

Diverticula Or Local Sacculations of the esophageal wall may be due to pressure from within, pressure diverticula, or to traction from without, traction diverticula.

The pressure diverticula are more common at the upper part in the mid-line, posteriorly, of the tube, where the greatest pressure occurs. There is loss of tone of the muscular coat and the mucous membrane projects in the form of a pouch from the posterior wall at the pharyngeal junction. They may be very small or as large as a pear. They communicate with the lumen of the esophagus and become rilled with food which is retained. This frequently undergoes decomposition, sets up inflammatory changes in the mucosa and adjacent tissues and may rupture.

Traction Diverticula

Traction Diverticula are more common and are found near the lower end of the esophagus at the bifurcation of the trachea. They are the result of the contraction of adhesions of diseased bronchial glands, usually tuberculous. Are generally on the anterior wall and are conical in shape with the apex directed outward at the seat of the adhesion. There may be no change in the constituents of the wall, or the muscular coat may be lacking. Perforation may occur if the tension at the apex becomes too great. Escape of the contents may take place into the pleura, pericardium, or lungs. Death may result from hemorrhage following perforation of a pulmonary artery.

Perforation of the esophagus may depend upon causes acting either from within or from without. It may follow from ulcerations caused by the pressure of the cricoid cartilage in bed-ridden patients, or from syphilitic or cancerous ulcers. It may be due to outside pressure from caseating glands, abscesses, gummata, or aneurysms of the aorta. Rupture may be the result of traumatism or be spontaneous. Inflammation to the grade of gangrene may follow the escape of material from the perforated esophagus. If the gastric contents regurgitate there may be a partial digestion of the 25 walls of the esophagus. This may, however, be a post-mortem condition.

Tumors are not very common, although of the connective-tissue tumors the fibroma, myxoma, myoma, lipoma, and more rarely sarcoma have been observed. The most common growth is the squamous epithelioma. It is most frequently found in the lower third at the place where the left bronchus crosses over. The growth is flat, more or less ring-like, and usually ulcerated. The mucous coat is destroyed and papillary projections extend into the esophagus and cause obstruction of the lumen. The submucosa and the muscular coat may become infiltrated and the adjacent tissues also involved. There is stenosis with subsequent dilatation above the tumor. Food is retained and ulceration with perforation may occur, usually into the larger air passages. Metastatic growths are found in the neighboring lymph-nodes, bronchi, pleura, lungs, and liver.