An esophageal rupture is a tear in the esophagus, the passageway from the throat to the stomach. It is a medical emergency, requiring prompt diagnosis and treatment. The esophagus may be ruptured by forceful vomiting, chemical injury, trauma or other disorders of the esophagus, such as esophageal cancer. Chest pain from a large tear in the esophagus may mimic symptoms of a heart attack. Leakage of esophageal contents such as saliva, food or vomit into the neighboring chest cavity can cause chemical injury or a serious bacterial infection or abscess. Treatment usually involves surgery to repair the tear and remove esophageal contents from the chest cavity, combined with antibiotics to prevent or treat a bacterial infection. If the esophagus has been severely damaged, surgical removal of part or all of the esophagus may be necessary.
What Causes Esophageal Rupture?
- Forceful vomiting
- Ingestion of a foreign object
- Ingestion of lye or other corrosive chemical
- Infection, ulcer or cancer of the esophagus
- Trauma, such as an automobile accident
- Accidental injury from insertion of tubes or instruments into the esophagus during medical procedures. (Approximately half of esophageal ruptures are caused this way.)
- Lifting a heavy object or straining during defecation
- Straining during defecation
Symptoms of Esophageal Rupture?
- Moderate or severe chest pain that may worsen upon breathing or swallowing following an episode of retching or vomiting
- Rapid, shallow breathing, difficulty breathing (dyspnea)
- Excessive sweating
- Subcutaneous emphysema
- Abdominal or back pain
- Difficulty swallowing (dysphagia)
- Nausea or vomiting, sometimes with blood
- Low blood pressure (hypotension)
- Rapid heart rate
Prevention of Esophageal Rupture
- Keep small objects and household chemicals that may be swallowed away from young children.
- Obtain prompt treatment for disorders that cause severe nausea and vomiting.
Diagnosis of Esophageal Rupture
- Chest x-ray may be performed. You may be required to swallow a contrast material to clearly identify the site of rupture in the esophagus.
- Flex esophagoscopy can be used to identify and locate perforations and determine the extent of injury, whether transmural or mucosal.
- Chest CT scan may be used to detect esophageal cancer or an abscess in the ches.
How to Treat Esophageal Rupture
- Surgical repair of the rupture is necessary for all but relatively small tears. In cases of severe esophageal damage, the affected portion of the esophagus may be removed surgically.
- Small tears can often be treated medically. In such cases, the patient will not be permitted to eat and oral suction may be used to keep the esophagus empty.
- Intravenous fluids and nutrients may be administered to maintain hydration and nutrition until the tear has healed.
- Intravenous antibiotics may be administered to treat or prevent an associated bacterial infection.
- If fluid has collected around the lungs, a chest tube may be used to drain the fluid.
- If fluid has collected in the area behind the breastbone and between the lungs (called the mediastinum), a procedure called a mediastinoscopy may be performed.
When to Call a Doctor
- EMERGENCY Call an ambulance for any severe chest pain. Heart attack, esophageal tear, and other serious disorders will need to be ruled out.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media