Esophageal perforation: All you need to know

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Esophageal perforations can happen for different reasons. Some causes that may lead to rupture in the esophagus include:

• traumatic penetrative injuries due to external forces
• complications of other underlying conditions that cause ulcers in the throat, such as acid reflux
• impact injuries
• certain medical procedures, such as endoscopy
• accidentally swallowing a sharp object or corrosive liquid, such as bleach
• spontaneous perforation due to a buildup of pressure in the esophagus

People with Boerhaave syndrome may experience spontaneous perforation of their esophagus. This is because a person with this condition may experience violent vomiting, raising the pressure in the esophagus and leading to its rupture.

The symptoms of esophageal perforation typically include pain near the perforation site and difficulty swallowing. However, symptoms may vary depending on the causes of the perforation and the extent of the injury.

Other symptoms of esophageal perforation include:

• nausea and vomiting
• pain or stiffness in the neck, if the perforation has occurred in the cervical area
• hoarseness or other changes in voice tone
• chills
• blood in the vomit
• low blood pressure
• increased heart rate
• chest wall palpitations
• fast breathing
• fever
• skin discoloration

Doctors typically use X-rays and CT scans to diagnose esophageal perforation. These imaging tests can also provide valuable information, including whether air bubbles are present in the esophagus or infections in the chest.

The dye used during the CT scan can also help determine the location and extent of the perforation. According to research, about 25% of esophageal ruptures occur in the cervical area. The chest area is the most common location for esophageal perforation, with about 55% of total ruptures developing there. The abdominal area is the least common, with only 20% of cases involving this region of the body.

The preferred treatment for esophageal perforation and trauma is surgery.

Surgery

In some cases, people with esophageal perforation may need to undergo surgery. During this procedure, a doctor drains the fluids that have leaked out of the esophagus and removes the dead tissues that infection may have caused.

They will then proceed with repairing the perforated esophagus. Depending on the extent of the damage, doctors may decide to carry out an open surgery rather than another less invasive form of surgery.

Doctors may also need to install a feeding tube, as people cannot swallow during their recovery.

Other treatments

These may include:

• Intravenous fluids: This is for restoring fluid levels lost while vomiting, bleeding, or having difficulties swallowing.
• Intravenous medications: Doctors may give antibiotics and antifungal drugs to reduce the risk of infections.
• Percutaneous drainage: This procedure removes the fluids that may have leaked from the esophagus into the body’s cavity.
• Endoscopic stent placement: For small ruptures, doctors may consider fixing the perforation by placing a stent during an endoscopic procedure instead of performing surgery. During this procedure, a doctor passes an endoscope down the person’s throat, reaching the site where the rupture occurred. They will then place a stent, sutures, or clips to repair the hole.

Esophageal perforation is a life threatening condition that requires immediate attention. In about 36–50% of cases, esophageal perforation is fatal. However, the outlook may vary depending on the extent and cause of the injury.

Receiving a prompt diagnosis and treatment within 24 hours of the perforation occuring can significantly improve the outcome of a person with a perforated esophagus. The condition has a 10–25% mortality rate among those who seek treatment within 24 hours.

Left untreated, esophageal perforation can lead to complications, including:

• pneumothorax (collapsed lung), where air leaks into the cavity between the lungs and the chest wall
• infection
• septicemia, which happens when germs enter the bloodstream
• subcutaneous emphysema, where air becomes trapped in tissues beneath the skin
• necrosis (cell death) in the tissues inside the chest

These complications are life threatening and may cause death.

A person should seek immediate medical attention if they experience any symptoms of esophageal perforation, such as severe chest pain, difficulty breathing, or difficulty swallowing.

Other reasons to contact a doctor may include:

• swallowing something that could damage the lining of the esophagus
• having a known condition that can cause the rupture of the esophagus
• sustaining significant trauma

Early diagnosis can significantly improve the outcome of esophageal perforation. Doctors can proceed with providing appropriate treatment to repair the rupture.

Here are some common questions about esophageal perforation:

Is esophageal perforation curable?

Esophageal perforation is curable. A doctor may need to perform surgery to repair the hole in the esophagus.

What is the survival rate for esophageal perforation?

Esophageal perforation is life threatening. Roughly 36–50% of people with esophageal perforation may develop complications and die. However, a prompt diagnosis and treatment can significantly improve the outcome of those with this condition.

What is the recovery time like?

The recovery time of esophageal perforation may vary depending on the extent of the damage and the type of surgery a person needs to repair the tear in their esophagus. People who undergo less invasive surgical procedures typically recover quicker.

Esophageal perforation is a life threatening condition that requires prompt treatment. It may happen as a complication of an underlying condition or as a result of trauma, particularly from penetrating injuries such as gunshot wounds.

Doctors typically perform surgery to treat the rupture of the esophagus. Depending on the extent of the damage, doctors may treat esophageal perforation with minimally invasive surgical procedures such as endoscopy. However, in more severe cases, people may need to undergo open surgery.