Esophageal ruptures are tears that penetrate the wall of the esophagus.
Ruptures can be caused by surgical or endoscopic procedures, severe vomiting, or swallowing a large piece of food that becomes stuck in the esophagus, but some ruptures occur spontaneously.
Symptoms include chest and abdominal pain, fever, and low blood pressure.
Esophageal rupture can be fatal.
The diagnosis is based on the results of x-rays.
Treatment is surgical repair.
The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus and Overview of Esophageal Injuries.)
Rupture of the esophagus is a very serious condition that is usually caused during endoscopy (examination of the esophagus with a flexible viewing tube) or other procedures in which instruments are inserted through the mouth and throat. Ruptures also may occur during vomiting, retching, or swallowing a large piece of food that becomes stuck in the esophagus.
Some ruptures occur spontaneously, especially in people who have untreated eosinophilic esophagitis.
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.
Symptoms of Esophageal Ruptures
Symptoms of rupture of the esophagus include chest pain, abdominal pain, vomiting, vomiting blood, low blood pressure, and fever. Doctors also may detect a crackling or crunching sound or sensation, caused by small air bubbles, under the skin.
Diagnosis of Esophageal Ruptures
CT esophagography
Esophagography
Sometimes endoscopy
Sometimes x-rays of the chest and abdomen
X-rays of the chest and abdomen often show air in the mediastinum.
Doctors confirm the diagnosis of esophageal perforation by doing CT esophagography or barium esophagram (and rarely standard esophagography). In these radiology tests, doctors take an CT scan, 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.
Doctors sometimes use endoscopy in cases where the diagnosis is unclear.
Treatment of Esophageal Ruptures
Surgical repair
Endoscopic or surgical repair of the esophagus and drainage of the area surrounding it are done, usually immediately. Before repair, doctors give antibiotics to prevent infection and fluids by vein (intravenously) to treat low blood pressure.
Some people, in whom esophageal perforation is diagnosed before serious complications have occurred, and is contained in a small area, may heal under close observation without surgery or endoscopic treatment.
Even with treatment, the risk of death is high, occurring in between about 20 to 30% of people.
