Oesophagus

The oesophagus runs from the pharynx to the cardia and has a short cervical part, a longer intrathoracic part and a short upper abdominal part. It runs behind and is closely approximated to the trachea as far as the bifurcation, and the arch of the aorta crosses it. The least protected part of the oesophagus is the lower intrathoracic section and this is where spontaneous rupture generally occurs. The entrance to the abdomen is controlled by slips of the diaphragm called crurae and if these become lax then a sliding or paraoe-sophageal hernia may occur. Sliding hernias are associated with dysfunction of the natural valve occurring at the cardia and are often associated with acid reflux leading to reflux oesophagitis and sometimes stricture formation.

Posterior

Anterior

Posterior

Anterior

Figure 18.4. Mediastinum showing divisions.

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