What is an Esophageal Perforation?

Jacquelyn Gilchrist

The esophagus is the part of the body that conducts food from the mouth to the stomach. An esophageal perforation means that the esophagus has a hole in it. If this occurs, the food may then travel into the chest area, called the mediastinum.

Chest x-rays can be used to help diagnose an esophageal perforation.
Chest x-rays can be used to help diagnose an esophageal perforation.

There are several possible causes of an esophageal perforation. During another medical procedure, the esophagus may be damaged with the surgeon’s instruments. This rarely occurs with more modern, flexible instruments. A tumor may also cause damage to the esophagus, tearing it. Or the area could be injured due to trauma.

Surgery can repair an esophageal perforation.
Surgery can repair an esophageal perforation.

Patients who suffer from gastroesophageal reflux disease (GERD) may experience damage to the esophagus. In severe cases, it may cause holes in it. Esophageal perforation may also be due to extremely violent vomiting. A patient can also tear the esophagus by swallowing an object or some caustic chemicals.

The most noticeable and common symptom of an esophageal perforation is pain. Patients may also be unable to breathe properly. They may notice chest pain and problems swallowing. Some people may develop a fever, a rapid heart rate, and low blood pressure. Additionally, if the esophageal perforation is toward the top of the esophagus, the patient may notice neck stiffness or pain, as well as air bubbles under the skin.

A quick diagnosis is critical for the survival of the patient. Esophageal perforation may be diagnosed with a chest x-ray to reveal any fluid leaks. X-rays can also help a doctor determine the exact location of the hole.

Typically, most patients should undergo surgery within 24 hours. Prior to an operation, patients may have fluids administered intravenously to ensure hydration. The doctor may also administer antibiotics to prevent an infection. A chest tube can be used to drain the fluids around the lungs. The physician may also use a device called a bronchoscopy, which is used to remove fluid from the chest cavity.

Surgery may be able to repair the esophageal perforation. If the patient has a severe medical condition, the esophagus may need to be removed. The sooner the patient undergoes surgery, the better his prognosis typically is.

Sometimes, a patient may be able to avoid surgery. This may be possible if there is little or no leakage, in which case, the surgeon can place a stent in the esophagus. Perforations in the upper part of the esophagus may be able to heal by themselves. A patient in such a situation will be unable to eat or drink until it is healed. These patients can use a stomach feeding tube instead.

As with any surgery, there is the potential for complications. The patient may have permanent esophageal damage, such as narrowing. He may also develop an infection. Or an abscess could form around the esophagus.

An esophageal perforation is a serious medical condition. If it is left untreated, the patient could go into shock, and the condition may be fatal. Patients who undergo successful surgeries within 24 hours typically have a good prognosis. Any delay in treatment can be fatal.

Intravenous fluids may be given to prevent or treat dehydration.
Intravenous fluids may be given to prevent or treat dehydration.

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