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Esophageal Ruptures


Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Reviewed/Revised Mar 2022 | Modified Sep 2022

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

  • Ruptures can be caused by surgical 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.

Rupture of the esophagus is a very serious condition that is usually caused during endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more (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. Such rupture is called Boerhaave syndrome. Some ruptures occur spontaneously, especially in people who have untreated eosinophilic esophagitis Eosinophilic Esophagitis Eosinophilic esophagitis is an inflammatory disorder in which the wall of the esophagus becomes filled with large numbers of eosinophils, a type of white blood cell. This disorder may be caused... read more .

An esophageal rupture allows air, stomach acid, and/or food to leave the esophagus, which causes severe inflammation in the chest (mediastinitis Mediastinitis Mediastinitis is inflammation of the mediastinum (the chest cavity, which contains the heart, the thymus gland, some lymph nodes, and parts of the esophagus, aorta, thyroid, and parathyroid... read more ). Fluid may collect around the lungs, a condition called pleural effusion Pleural Effusion 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.

Diagnosis of Esophageal Ruptures

  • X-rays of the chest and abdomen

  • Esophagography

To diagnose ruptures of the esophagus, doctors take x-rays of the chest and abdomen.

Doctors confirm the diagnosis by doing esophagography. In this test, doctors take an x-ray or video of the esophagus after the person swallows a liquid (a contrast agent Radiographic Contrast Agents Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... read more ) 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.

Treatment of Esophageal Ruptures

  • Surgical repair

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 low blood pressure.

Even with treatment, the risk of death is high.

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