A rupture or tear in the esophagus, also known as an esophageal perforation, is a serious medical condition that requires immediate attention. Infection, sepsis, and even death can result if not treated promptly, so here's an overview of esophageal perforation, including its causes, symptoms, diagnosis, treatment, and prevention.
Causes
There are a number of factors that can cause esophageal perforation, including:
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As a result of trauma to the chest or abdomen, such as a car accident or a fall, the esophagus can tear.
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Injuries caused by medical procedures or surgeries involving the esophagus, such as endoscopy or esophageal dilation.
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The esophageal wall can be punctured by foreign objects or bones accidentally ingested.
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The Boerhaave Syndrome is characterized by a spontaneous rupture of the esophagus, usually accompanied by vomiting or retching.
Symptoms
There can be a variety of symptoms associated with esophageal perforation depending on the location and severity of the tear, but some of the most common include:
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Sudden, intense chest pain, often described as stabbing or tearing.
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Pain or discomfort with swallowing, accompanied by the sensation that food or liquid is leaking into the chest.
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A swelling or crackling sensation under the skin of the neck, chest, or abdomen caused by subcutaneous emphysema.
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A fever, chills, and increased heart rate are signs of infection.
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Breathing problems or shortness of breath, especially if the perforation involves the lungs.
Diagnosis
The diagnosis of esophageal perforation usually involves a combination of clinical evaluation and diagnostic tests. Diagnostic steps may include the following:
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Your healthcare provider will assess signs of esophageal injury by reviewing your symptoms, medical history, and performing a physical examination.
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An X-ray of the chest, a computed tomography scan, or a contrast esophagram may be used to visualize the esophagus and identify any abnormalities.
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The extent of the perforation can be assessed using esophagoscopy, a procedure that allows direct visualization of the esophagus.
Treatment
The treatment of esophageal perforation involves stabilizing the patient, repairing the tear, and preventing complications. Treatment options include:
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Keeping the patient nil per os (NPO), or nothing by mouth, to prevent further injury and reduce the risk of aspiration.
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If the perforation is associated with mediastinum contamination, antibiotics are administered to prevent or treat infection.
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Large or complex perforations may require surgical intervention to repair the tear and remove necrotic tissue.
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Stenting: The placement of a stent or endoluminal prosthesis to seal a perforation and promote healing, particularly in cases of iatrogenic injury.
Prevention
It may not always be possible to prevent esophageal perforation, especially in cases of traumatic injury or unforeseen complications. However, some precautions may help reduce the risk, including:
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To avoid accidental ingestion of foreign bodies, chew food thoroughly and avoid large or difficult-to-swallow objects.
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Assuring that medical procedures involving the esophagus, including endoscopy or esophageal dilation, are performed safely by trained professionals.
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Treatment of esophageal disorders promptly can prevent complications which may lead to perforation, such as GERD, esophageal strictures, and esophageal cancer.
The diagnosis and treatment of esophageal perforation are essential for a favorable outcome and to avoid complications.
