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Esophageal Ruptures

By Kristle Lee Lynch, MD, Assistant Professor of Medicine, Perelman School of Medicine at The University of Pennsylvania

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.