Oesophageal rupture (tear in the esophagus)

Chest | Gastroenterology | Oesophageal rupture (tear in the esophagus) (Disease)


Description

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.

Causes and Risk factors

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.

Diagnosis and Treatment

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.

Today, most instances of esophageal perforation are iatrogenic, but this remains a potentially devastating condition. Rapid diagnosis and therapy provide the best chance for survival; however, delay in diagnosis is common, resulting in substantial morbidity and mortality.

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 in the area behind the breastbone and between the lungs (called the mediastinum), a procedure called a mediastinoscopy may be performed.

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