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Esophageal Ruptures

By Michael C. DiMarino, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University

Esophageal ruptures are tears that penetrate the wall of the esophagus.

Ruptures of the esophagus are usually caused during endoscopy (examination of the esophagus with a flexible viewing tube (see Endoscopy) or other procedures in which instruments are inserted through the mouth and throat. Ruptures also may occur during vomiting, retching, or swallowing a large mass of food. Such rupture is called Boerhaave syndrome.

An esophageal rupture allows air, stomach acid, and/or food to leave the esophagus, which causes severe inflammation in the chest (mediastinitis). Fluid may collect around the lungs, a condition called pleural effusion (see Pleural Effusion).

Symptoms include chest pain, abdominal pain, vomiting, vomiting blood, and shock.

Doctors take x-rays of the chest and abdomen. Doctors confirm the diagnosis by taking an x-ray or video of the esophagus after the person swallows a liquid (a contrast agent) that makes the lining of the esophagus visible on the x-ray. They must use a special type of contrast agent that does not irritate the chest cavity.

Surgical repair of the esophagus and drainage of the area surrounding it are done immediately. Before surgical repair, doctors give broad-spectrum antibiotics to prevent infection and fluids by vein (intravenously) to treat shock. Even with treatment, the risk of death is high.

* This is the Consumer Version. *