Esophageal rupture

Esophageal rupture is a medical condition characterized by a full-thickness tear in the esophagus, the muscular tube that connects the throat to the stomach. This condition is considered a medical emergency due to the risk of leaking of stomach contents into the surrounding areas, leading to severe infection and complications. Esophageal rupture can occur spontaneously, as in Boerhaave syndrome, or as a result of trauma, medical procedures, or ingestion of caustic substances.

Causes

Esophageal rupture can be caused by several factors, categorized into spontaneous, iatrogenic, traumatic, and chemical causes:

• Spontaneous rupture (Boerhaave syndrome) typically occurs after forceful vomiting or retching.
• Iatrogenic causes include injuries from medical procedures such as endoscopy or surgeries.
• Traumatic rupture can result from blunt or penetrating trauma to the chest or abdomen.
• Chemical causes involve the ingestion of caustic or corrosive substances, leading to esophageal damage and potential rupture.

Symptoms

Symptoms of esophageal rupture may include:

• Severe chest pain, often radiating to the back
• Vomiting or retching followed by severe pain (in cases of Boerhaave syndrome)
• Difficulty swallowing (dysphagia)
• Shortness of breath (dyspnea)
• Fever
• Rapid heart rate (tachycardia)
• Subcutaneous emphysema (air present under the skin)

Diagnosis

Diagnosis of esophageal rupture involves a combination of medical history, physical examination, and diagnostic tests, including:

• Chest X-ray to detect air in the chest cavity (pneumothorax or pneumomediastinum)
• Computed tomography (CT) scan of the chest and abdomen to provide detailed images of the esophagus and surrounding structures
• Esophagogram with a water-soluble contrast agent to visualize the rupture
• Endoscopy to directly visualize the tear in the esophagus

Treatment

Treatment of esophageal rupture is aimed at closing the tear, preventing infection, and supporting the patient through recovery. Treatment options include:

• Surgical repair of the esophageal tear
• Administration of antibiotics to prevent or treat infection
• Nutritional support, often through a feeding tube or intravenous (IV) nutrition, to allow the esophagus to heal
• In some cases, non-surgical management may be considered if the patient is stable and the rupture is contained

Complications

Complications of esophageal rupture can be severe and include:

• Mediastinitis (inflammation of the mediastinum, the central compartment of the thoracic cavity)
• Sepsis (a life-threatening response to infection)
• Pneumothorax (collapsed lung)
• Empyema (accumulation of pus in the pleural cavity)
• Death, if not promptly and effectively treated

Prevention

Prevention of esophageal rupture involves managing risk factors and avoiding actions that increase pressure on the esophagus, such as:

• Avoiding excessive alcohol consumption
• Managing chronic vomiting or retching with medical treatment
• Exercising caution during medical procedures involving the esophagus

See also

• Esophagus
• Boerhaave syndrome
• Mediastinitis
• Sepsis