FIGURE 124.4 A child with chronic partial obstruction of the esophagus caused by a congenital web Similar bulbous enlargement of the proximal esophagus can occur with any type of stricture and results in pressure on the trachea and recurrent regurgitation with aspiration T4, 4th thoracic vertebrae Clinical Recognition Clinical findings range from a normal physical examination to respiratory distress and hemodynamic instability Most patients will complain of oropharyngeal discomfort, odynophagia, dysphagia, and chest pain Stridor may indicate laryngeal and epiglottic edema, and if accompanied by drooling should raise suspicion for esophageal injury Other signs of esophageal injury include dysphagia, retrosternal pain, epigastric pain, and hematemesis However, clinical symptoms may be poor predictors of the extent of injury Ominous signs include hemodynamic instability, fever, tachycardia, and mental status changes; such findings raise concern for esophageal perforation and developing mediastinitis Management Initial management includes the assessment of the severity of injury and the prevention of further injury If possible, the type and amount of corrosive agent