Esophageal rupture

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Esophageal rupture
Esophageal rupture
Synonyms	Boerhaave syndrome
Pronounce	N/A
Specialty	N/A
Symptoms	Severe chest pain, vomiting, subcutaneous emphysema
Complications	Mediastinitis, sepsis, pneumothorax
Onset	Sudden
Duration	Acute
Types	N/A
Causes	Forceful vomiting, trauma, endoscopy
Risks	Alcoholism, eating disorders, hiatal hernia
Diagnosis	Chest X-ray, CT scan, esophagography
Differential diagnosis	Myocardial infarction, aortic dissection, peptic ulcer disease
Prevention	N/A
Treatment	Surgical repair, antibiotics, drainage
Medication	N/A
Prognosis	Variable, depends on time to treatment
Frequency	Rare
Deaths	N/A

Esophageal Rupture

Chest X-ray showing pneumomediastinum

An esophageal rupture is a medical condition where there is a tear or hole in the esophagus, the muscular tube that connects the throat to the stomach. This condition can lead to serious complications if not treated promptly, as it allows the contents of the esophagus to leak into the surrounding areas, potentially causing infection and inflammation.

Causes

Esophageal ruptures can occur due to various reasons, including:

• Trauma: Physical injury to the chest or neck can cause a rupture.
• Medical Procedures: Endoscopic procedures or surgeries involving the esophagus can sometimes lead to accidental perforation.
• Boerhaave Syndrome: This is a spontaneous rupture of the esophagus due to a sudden increase in intraesophageal pressure, often caused by severe vomiting.
• Foreign Bodies: Swallowing sharp objects can puncture the esophagus.
• Infections: Severe infections can weaken the esophageal wall, leading to rupture.

Symptoms

The symptoms of an esophageal rupture can vary but often include:

• Severe chest pain
• Difficulty swallowing (dysphagia)
• Vomiting, which may contain blood
• Rapid breathing and heart rate
• Fever and signs of infection

Diagnosis

Diagnosis of an esophageal rupture is typically made through imaging studies and clinical evaluation. Common diagnostic tools include:

• Chest X-ray: Can show signs of air in the mediastinum (pneumomediastinum) or pleural effusion.
• CT Scan: Provides detailed images and can confirm the presence of a rupture.

CT scan of Boerhaave syndrome

Treatment

Treatment for an esophageal rupture is a medical emergency and often requires surgical intervention. The main goals of treatment are to:

• Repair the rupture
• Drain any fluid collections
• Prevent or treat infection

In some cases, conservative management with antibiotics and nutritional support may be considered if the rupture is contained and the patient is stable.

Prognosis

The prognosis for an esophageal rupture depends on the size and location of the tear, the time to diagnosis and treatment, and the overall health of the patient. Early diagnosis and treatment are crucial for a favorable outcome.

See also

• Esophagus
• Boerhaave syndrome
• Pneumomediastinum
• Dysphagia