Question
A 68-year-old man comes to the physician because of a 4-month history of difficulty swallowing. During this time, he has also had a 7-kg (15-lb) weight loss. Esophagogastroduodenoscopy shows an exophytic mass in the distal third of the esophagus. Histological examination of a biopsy specimen shows a well-differentiated adenocarcinoma. The patient is scheduled for surgical resection of the tumor. During the procedure, the surgeon damages a structure that passes through the diaphragm along with the esophagus at the level of the tenth thoracic vertebra (T10). Which of the following structures was most likely damaged?
| A. |
Aorta
|
| B. |
Inferior vena cava
|
| C. |
Vagus nerve
|
| D. |
Thoracic duct
|
Show Answer
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Correct Answer � C
Explanation
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|
Answer C) Vagus nerve
Explanation: Damage to this structure may cause gastroparesis.
Vagus nerve:
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The vagus nerve (cranial nerve X) exits the thoracic cavity together with the esophagus through the esophageal hiatus, a diaphragmatic aperture at the level of T10, and innervates the smooth muscle cells of the digestive tract.
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Periesophageal vagus nerve injury, which may occur during thoracic or gastric surgery, typically manifests with delayed gastric emptying.
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Other symptoms of vagus nerve injury depend on the level at which the lesion is located and include loss of the gag reflex, vocal cord paralysis (manifesting as hoarseness), and autonomic dysfunction (e.g., impaired heart rate variability).
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Further causes of vagus nerve injury include diabetic neuropathy, trauma, and inflammation.
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