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enterocolitis , chronic pancreatitis , postgastrointestinal resection , or esophageal stricture , stenosis , or obstruction ) , the resultant interference with nutrition will be considered under the criteria in 5.08 . Furthermore , the rate of perforation is increased in the presence of a large hiatal hernia or esophageal diverticula . Cotton recommends a barium swallow to evaluate for aspiration , spastic esophageal disease , or esophageal stricture . The Jackson Clinic was a magnet for patients from around the world suffering from airway and esophageal foreign bodies . Other causes of pulsus paradoxus include hypovolemia and either a large or small airway obstruction like with epiglottitis or asthma.Causes : Most cases of purulent pericarditis are associated with a preexisting or concurrent infection such as pneumonia with or without empyema , meningitis , osteomyelitis , arthritis , or other soft tissue infections.Patients recovering from thoracic , cardiac , or esophageal surgery are at risk for purulent pericarditis.Purulent pericarditis has been reported in patients recovering from traumatic injury.The organisms that most commonly cause purulent pericarditis are Staphylococcus aureus , H influenzae , Neisseria meningitidis , and Streptococcus pneumoniae.Less common organisms include gram-negative enteric bacilli , Pseudomonas aeruginosa , Salmonella species , Francisella tularensis , and anaerobic bacteria and fungi ( Histoplasma species , coccidioidomycosis , blastomycosis , Aspergillus species , Candida species ) . Available evidence from prospective cohort studies did not show statistically significant associations of vitamin C and reduced risk of oral , pharyngeal , or esophageal cancer . Both airway and esophageal foreign bodies if not promptly removed can cause erosion of the viscera with consequential neck or mediastianal abscess , or tracheoesophageal fistula . Many alternative treatments for airway and esophageal foreign bodies have been proposed but rigid endoscopy has proven over time to be the safest and most efficacious therapy . The link between iron deficiency and esophageal webs remains controversial . Indications for immediate surgery include ( 1 ) a massive air leak following chest tube insertion ; ( 2 ) a massive hemothorax or continued high rate of blood loss via the chest tube ( ie , 1500 mL of blood upon chest tube insertion or continued loss of 250 mL / h for 3 consecutive hours ) ; ( 3 ) radiographically or endoscopically confirmed tracheal , major bronchial , or esophageal injury ; and ( 3 ) the recovery of gastrointestinal tract contents via the chest tube . Dr. Litle has extensive experience in thoracoscopic / laparoscopic ( minimally invasive ) esophagectomy , laparoscopic anti-reflux surgery and repair of giant paraesophageal hernias and minimally invasive palliation of advanced airway and esophageal malignancies including use of stents and photodynamic therapy . Esophageal strictures from caustic injury develop in 15-38 % of cases and occur as early as 2 weeks after caustic exposure.Uncommon causes of lower esophageal rings include pill-induced esophagitis , rare skin disorders such as epidermolysis bullosa dystrophica , benign mucous membrane pemphigoid , and mediastinal radiation.Upper esophageal websThe association between iron deficiency and esophageal webs is controversial . Ketoconazole ( Nizoral ) : an antifungal medication available in pill and liquid form that is effective against a variety of fungal infections such as oral , vaginal and esophageal THRUSH and cryptococcosis ( see CRYPTOCOCCUS ) .