Oesophagus

Contents

The oesophagus is a fibromuscular tube, approximately 25cm in length, that transports food from the pharynx to the stomach.

Inferior border of cricoid cartilage or cricopharyngeus muscle at the level of C6
Continuous with laryngopharynx superiorly

Cervical
- Commences at the upper oseophageal sphincter, formed by the cricopharyngeus muscle.
- Descends slightly left of midline, between trachea and vertebral column
Thoracic
- Enters thorax via the superior thoracic aperture, descends through posterior mediastinum
- Courses slightly anteriorly following curvature of thoracic spine
- Passes anteriorly to the left near diaphragm to lie anterior to thoracic aorta
- At the distal thoracic oseophagus, there is a bulbous distension called the vestibule (or phrenic ampulla), which corresponds to the lower oseophageal sphincter.
  - It is defined superiorly by the tubulovestibular junction and inferiorly by the upper margin of the gastric sling fibres.
Abdominal
- Enters abdominal cavity via the oesophageal hiatus (an opening formed by the right crus of diaphragm) at level of T10

Following short intra-abdominal course to the left, joins the cardiac orifice of stomach at level of T11

Anterior: trachea (up to T4/T5), left main bronchus, right pulmonary artery, base of heart, diaphragm
Posterior: vertebral bodies and prevertebral fascia, danger space, longus coli muscle, thoracic duct, descending aorta (posterolaterally to left), hemiazygos and accessory azygos veins, right posterior intercostal arteries (except 1st and 2nd)
Left: Aorta, left subclavian artery, thoracic duct
Right: Azygos vein, right superior intercostal vein
Bilateral: recurrent laryngeal nerves in tracheoesophageal groove, carotid sheaths, lung and pleura

The table below lists the anatomical relations of the oesophagus:

	Anterior	Posterior	Right	Left
Cervical and thoracic	Trachea Left recurrent laryngeal nerve Pericardium	Thoracic vertebral bodies Thoracic duct Azygous veins Descending aorta	Pleura Terminal part of azygous vein	Subclavian artery Aortic arch Thoracic duct Pleura
Abdominal	Left vagus nerve Posterior surface of the heart	Right vagus nerve Left crus of the diaphragm

Upper third (skeletal muscle)

Middle third (mixed skeletal/smooth muscle)

Lower third (smooth muscle)

[icon name=”lightbulb” prefix=”far” style=”padding-right:10px;”]The physiological constrictions can be remembered as ABCD

Oesophageal bronchus – bronchus arises from oesophagus
Oesophageal atresia – passage is closed or absent
Abberant right subclavian artery – right subclavian artery arises as fourth branch of aorta, coursing posterior to the oesophagus or between oesophagus and trachea. May cause compression.

Updated on 15 March 2022