Esophageal Constrictions-Carcinoma of the Lower Third of the Esophagus

Esophageal Constrictions

The esophagus has three anatomic and physiologic constrictions. The first is where the pharynx joins the upper end, the second is where the aortic arch and the left bronchus cross its anterior surface, and the third occurs where the esophagus passes through the diaphragm into the stomach. These constrictions are of considerable clinical importance because they are sites where swallowed foreign bodies can lodge or through which it may be difficult to pass an esophagoscope. Because a slight delay in the passage of food or fluid occurs at these levels, strictures develop here after the drinking of caustic fluids. Those constrictions are also the common sites of carcinoma of the esophagus. It is useful to remember that their respective distances from the upper incisor teeth are 6 in. (15 cm), 10 in. (25 cm), and 16 in. (41 cm), respectively

Carcinoma of the Lower Third of the Esophagus

The lymph drainage of the lower third of the esophagus descends through the esophageal opening in the diaphragm and ends in the celiac nodes around the celiac artery A malignant tumor of this area of the esophagus would therefore tend to spread below the diaphragm along this route. Consequently, surgical removal of the lesion would include not only the primary lesion, but also the celiac lymph nodes and all regions that drain into these nodes, namely, the stomach, the upper half of the duodenum, the spleen, and the omenta. Restoration of continuity of the gut is accomplished by performing an esophagojejunostomy