Early and late suspected instrumental esophageal perforation is assessed first by:

Ans. (b) CT ScanRef Bailey and Love 27h edition Page 1073/1074Instrumental Perforation:* Most common cause of esophageal perforation.* In upper GI scopy incidence =1:4000* Factors increasing risk of perforation:# Large anterior Cervical osteophytes# Pharyngeal pouch# Mechanical obstructions# Following biopsy of malignancy* Therapeutic endoscopy has 10 times increased risk than diagnostic studies* Cervical perforation manifests immediately as localized pain in neck, hoarseness, painful neck movements, subcutaneous emphysema* Intrathoracic or intra-abdominal perforations presents with chest pain, hemodynamic instability, oxygen desaturation, evidence of perforation visually, abdominal pain, etc.* Some patients present late at 24 hours with pyrexia and sepsis. Diagnosis:* Most cases diagnosed immediately by a chest X-ray.* If not recognized, early and late suspected perforations should be assessed by CT (which shows air or leaked oral contrast and any fluid collection).(Authors Point- Direct Line from Bailey in NBE. If you read Bailey Line by Line Surgery part of NBE paper is nothing)* If CT is not available - Water soluble contrast is advised but it cannot detect small leaks always* If water-soluble contrast negative and you have strong suspect do dilute barium swallow