II. Pathophysiology
- Rupture results in linear tear of the lower esophagus
- Following rupture, only mediastinal pleura contains esophageal contents
- Lower esophagus lacks serosal covering
- Esophageal contents leaks into mediastinum
- Pressure gradient changes with respirations
- Severe inflammation and infection follows
- Mediastinitis
- Empyema (following spread to pleural space)
III. Epidemiology
- Rare (but lethal if unrecongized)
IV. Causes
- Esophageal Cancer
- Esophageal Foreign Body
- Severe Retching or Vomiting (Mallory-Weis Tear)
-
Traumatic Injury
- Penetrating Chest Trauma
- Blunt force to left chest, Sternum or epigastrium
- Forces gastric contents into the esophagus
V. Precautions
- Consider in the injured patient with a left Pneumothorax or Hemothorax without a Rib Fracture
VI. Symptoms
- Melena
- Vomiting
-
Chest Pain
- Follows Retching
- Retrosternal pain radiates to back or epigastrium
- Pain increases with swallowing or neck movement
VII. Signs
- Sudden collapse and patient appears acutely ill
- Signs develop only gradually
- Subcutaneous Emphysema
- Mediastinal air
- Hamman's Crunch
- Pleural Effusion
VIII. Labs
IX. Diagnostics
-
Nasogastric Tube
- Aspirate with bloody fluid
-
Chest XRay
- Anterior displacement of trachea
- Mediastinal air (Mediastinal Emphysema)
- Pathognomonic of Esophageal Rupture
- Pleural Effusion
- Wide Mediastinum
-
Pneumothorax
- When Trauma-related it is often left sided and without Rib Fracture
- Chest Tube will show continued air leak and particulate matter
- Other studies
- Esophagram (Gastrografin or dilute barium)
- Gastroscopy (false negatives not uncommon)
- Chest CT
X. Management
- Emergent surgical intervention
- Survival rates are best with the earliest interventions (within hours of onset)
- Wide mediastinal drainage and esophageal wall repair
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| Definition (NCI_CTCAE) | A disorder characterized by a rupture in the wall of the esophagus. |
| Definition (NCI) | The presence of a hole or other type of opening in the esophageal wall through which the contents of the esophagus can pass into the mediastinum. The most common cause of esophageal perforation is injury during a medical procedure such as esophagoscopy or placement of a naso-gastric tube; and pathologic process such as neoplasm or gastric reflux with ulceration. Less common causes include injuries from penetrating or blunt trauma or injury to the esophagus during an operation on another organ, mechanical problem such as violent retching or vomiting; ingestion of a foreign body or caustic agents. The condition often results in infection of the mediastinum and mediastinitis. |
| Definition (MSH) | An opening or hole in the ESOPHAGUS that is caused by TRAUMA, injury, or pathological process. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D004939 |
| ICD9 | 530.4 |
| ICD10 | K22.3 |
| SnomedCT | 155676000, 23387001 |
| English | Esophageal Perforations, Perforation, Esophageal, Perforations, Esophageal, ESOPHAGEAL PERFORATION, OESOPHAGEAL PERFORATION, esophageal perforation, esophageal perforation (diagnosis), Esophageal perforation, Perforation esophagus, Oesophageal perforation, Perforation Of Esophagus, Esophageal Perforation [Disease/Finding], esophagus perforation, perforation esophagus, oesophageal perforation, perforation of esophagus, Perforation of oesophagus (disorder), Perforation oesophagus, PERFORATION OF ESOPHAGUS, Perforation of Esophagus, ESOPHAGUS, PERFORATION OF, Perforation of esophagus, Perforation of oesophagus, Perforation of esophagus (disorder), esophagus; perforation, perforation; esophagus, Esophageal Perforation |
| Portuguese | PERFURACAO ESOFAGICA, Perfuração do esófago, Perfuração esofágica, Perfuração Esofágica |
| German | OESOPHAGUSPERFORATION, Perforation des Oesophagus, Oesophagusperforation, Ösophagusperforation |
| Italian | Perforazione esofagea, Perforazione dell'esofago |
| Dutch | perforatie oesofagus, slokdarmperforatie, perforatie van slokdarm, oesofagus; perforatie, perforatie; oesofagus, Perforatie van slokdarm, oesofagusperforatie, Oesofagusperforatie, Perforatie, oesofagus-, Perforatie, slokdarm-, Slokdarmperforatie |
| Spanish | Perforacion de esófago, ESOFAGO, PERFORACION, perforación del esófago (trastorno), perforación del esófago, Perforación de esófago, Perforación del Esófago |
| Japanese | 食道穿孔, ｼｮｸﾄﾞｳｾﾝｺｳ |
| Swedish | Esofagusperforation |
| Czech | ezofágus - perforace, Perforace jícnu, Jícnová perforace |
| Finnish | Ruokatorven perforaatio |
| Russian | PISHCHEVODA PERFORATSIIA, ПИЩЕВОДА ПЕРФОРАЦИЯ |
| French | PERFORATION DE L'OESOPHAGE, Perforation de l'oesophage, Perforation oesophagienne, Rupture de l'oesophage |
| Korean | 식도의 천공 |
| Polish | Perforacja przełyku, Przedziurawienie przełyku |
| Hungarian | Nyelőcső perforatio, Oesophagus perforatio, Nyelőcső perforatiója, Oesophagealis perforatio |
| Norwegian | Oesophagusperforasjon, Øsofagusperforasjon, Spiserørsperforasjon, Perforasjon av spiserøret, Perforasjon av øsofagus |
Ontology: Rupture of esophagus (C0281839)
| Concepts | Injury or Poisoning (T037) |
| ICD10 | K22.3 |
| SnomedCT | 235626005 |
| Italian | Rottura esofagea, Rottura dell'esofago |
| French | Rupture oesophagienne, Rupture de l'oesophage |
| Portuguese | Rutura do esófago, Ruptura esofágica |
| Spanish | Rotura esofágica, disrrupción esofágica, Rotura de esófago, ruptura esofágica (trastorno), ruptura esofágica |
| Japanese | 食道破裂, ｼｮｸﾄﾞｳﾊﾚﾂ |
| Czech | Ruptura jícnu |
| English | esophagus rupture, oesophageal rupture, rupture esophagus, esophageal rupture, rupture of esophagus, Oesophageal rupture, Esophageal rupture, Bursting injury of esophagus, Bursting injury of oesophagus, Disruption of esophagus, Disruption of oesophagus, Rupture of oesophagus, Rupture of esophagus (disorder), esophagus; rupture, rupture; esophagus, Rupture of esophagus |
| Hungarian | Oesophagealis szakadás, Oesophagus ruptura |
| Dutch | oesofagus; ruptuur, ruptuur; oesofagus, slokdarmruptuur |
| German | Speiseroehrenriss |
