Esophagus
Esophageal Rupture
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Esophageal Rupture
, Esophageal Perforation, Boerhaave's Syndrome, Esophageal Tear
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)
Epidemiology
Rare (but lethal if unrecongized)
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
Precautions
Consider in the injured patient with a left
Pneumothorax
or
Hemothorax
without a
Rib Fracture
Symptoms
Melena
Vomiting
Retching
Hematemesis
Chest Pain
Follows
Retching
Retrosternal pain radiates to back or epigastrium
Pain increases with
Swallowing
or neck movement
Signs
Sudden collapse and patient appears acutely ill
Shock
Fever
Tachycardia
Signs develop only gradually
Subcutaneous
Emphysema
Mediastinal air
Hamman's Crunch
Pleural Effusion
Labs
Complete Blood Count
(CBC)
Leukocytosis
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 Negative
s not uncommon)
Chest
CT
Management
Emergent surgical intervention
Survival rates are best with the earliest interventions (within hours of onset)
Wide mediastinal drainage and esophageal wall repair
References
(2012)
ATLS
, 9th Ed, American College of Surgeons, Committee on
Trauma
, p. 108
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