Esophageal Rupture

The rupture of esophagus is a life-threatening condition. It is usually result of a serious structural damage to the esophagus, a feared complication of endoscopic examination.

Causes

The esophagus is more prone to perforation when its wall is affected by a pathological process. This includes more serious forms of reflux disease, esophageal cancer, conditions after local surgical interventions and esophageal caustic damage. Esophagus may be also damaged by swallowing a foreign body that gets stuck.  It can be just a big bite of food (typically beef meat), but children may swallow even more dangerous items such as batteries. The rupture of the esophagus can occur even in a very strenuous vomiting and we refer this situation to as the Boerhaave syndrome. However, this is a rare phenomenon compared to a less dangerous tearing of the esophageal mucosa (i.e. the whole esophageal wall is not perforated) known as the Mallory-Weiss syndrome.

 

Esophageal rupture is a dreaded complication of the upper GI endoscopy. This may be result of a careless insertion of the endoscopic device into the pharynx and upper esophagus, especially if the patient has an esophageal pouch known as Zenker's diverticulum, which may subsequently perforate. Of course, the chance of accidental perforation is increased in the above-mentioned risk factors.

Symptoms

The esophageal rupture manifests by severe chest pain, which may be shocking. There occurs pain during swallowing, which makes practically impossible to swallow any food. However, the main problem is a subsequent inflammation of the chest due to perforation of bacteria from the ruptured esophagus into the surrounding tissues. This state usually progresses into septic condition followed by a life-threatening septic shock (fever, pallor, palpitations, low blood pressure).

Diagnosis

If the rupture occurred during an upper GI endoscopy, the doctor can see the situation with his own eyes. The endoscopic device must be immediately pulled to minimize damage. In uncertain situation, the chest X-ray is very useful in finding air in the soft tissues of the chest. More precise information may bring computed tomography of the chest and neck.

Treatment

The patient must be hospitalized, prohibited from intake of food or fluids by mouth and administered intravenous infusions, antibiotics and painkillers. Small cracks in the upper part of the esophagus may theoretically heal spontaneously, but an endoscopic, or even surgical intervention is usually needed to close the ruptured organ. However, surgical solution is associated with a relatively high mortality rate.