Gastroenterology Book

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Esophageal Rupture

Aka: Esophageal Rupture, Esophageal Perforation, Boerhaave's Syndrome, Esophageal Tear
  1. Pathophysiology
    1. Rupture results in linear tear of the lower esophagus
    2. Following rupture, only mediastinal pleura contains esophageal contents
      1. Lower esophagus lacks serosal covering
    3. Esophageal contents leaks into mediastinum
      1. Pressure gradient changes with respirations
    4. Severe inflammation and infection follows
      1. Mediastinitis
      2. Empyema (following spread to pleural space)
  2. Epidemiology
    1. Rare (but lethal if unrecongized)
  3. Causes
    1. Esophageal Cancer
    2. Esophageal Foreign Body
    3. Severe Retching or Vomiting (Mallory-Weis Tear)
    4. Traumatic Injury
      1. Penetrating Chest Trauma
      2. Blunt force to left chest, Sternum or epigastrium
        1. Forces gastric contents into the esophagus
  4. Precautions
    1. Consider in the injured patient with a left Pneumothorax or Hemothorax without a Rib Fracture
  5. Symptoms
    1. Melena
    2. Vomiting
      1. Retching
      2. Hematemesis
    3. Chest Pain
      1. Follows Retching
      2. Retrosternal pain radiates to back or epigastrium
      3. Pain increases with swallowing or neck movement
  6. Signs
    1. Sudden collapse and patient appears acutely ill
      1. Shock
      2. Fever
      3. Tachycardia
    2. Signs develop only gradually
      1. Subcutaneous Emphysema
      2. Mediastinal air
      3. Hamman's Crunch
      4. Pleural Effusion
  7. Labs
    1. Complete Blood Count (CBC)
      1. Leukocytosis
  8. Diagnostics
    1. Nasogastric Tube
      1. Aspirate with bloody fluid
    2. Chest XRay
      1. Anterior displacement of trachea
      2. Mediastinal air (Mediastinal Emphysema)
        1. Pathognomonic of Esophageal Rupture
      3. Pleural Effusion
      4. Wide Mediastinum
      5. Pneumothorax
        1. When Trauma-related it is often left sided and without Rib Fracture
        2. Chest Tube will show continued air leak and particulate matter
    3. Other studies
      1. Esophagram (Gastrografin or dilute barium)
      2. Gastroscopy (false negatives not uncommon)
      3. Chest CT
  9. Management
    1. Emergent surgical intervention
      1. Survival rates are best with the earliest interventions (within hours of onset)
      2. Wide mediastinal drainage and esophageal wall repair
  10. References
    1. (2012) ATLS, 9th Ed, American College of Surgeons, Committee on Trauma, p. 108

Esophageal Perforation (C0014860)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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