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Esophageal Ruptures

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, University of Pennsylvania Health System

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.

The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach.

Rupture of the esophagus is a very serious condition that is usually caused during endoscopy (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.

An esophageal rupture allows air, stomach acid, and/or food to leave the esophagus, which causes severe inflammation in the chest (mediastinitis). Fluid may collect around the lungs, a condition called pleural effusion.

Symptoms

Symptoms of rupture of the esophagus include chest pain, abdominal pain, vomiting, vomiting blood, low blood pressure, and fever.

Diagnosis

  • 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) 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

  • 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.

* This is the Consumer Version. *