What Is Esophageal Perforation?
An esophageal perforation is a hole in the tube that food and
liquids pass through on the way from your mouth to your stomach. This tube is
called the esophagus. Perforation of the esophagus is uncommon, but it’s a
serious medical condition.
An esophageal perforation is usually repaired surgically. The
condition can be life-threatening if it’s left untreated.
What Are the Causes of Esophageal Perforation?
The esophagus is a long tube that connects your mouth to your
stomach. It’s divided into three sections:
- The cervical area is the part of the esophagus
inside your neck.
- The thoracic area is the part of the esophagus
in your chest.
- The abdominal area is the part of the esophagus that
leads to your stomach.
A perforation, or hole, can develop in any of these areas.
The most common cause of esophageal perforation is injury to the
esophagus during another medical procedure.
Any medical instrument used in a diagnostic or treatment procedure
can potentially rupture the esophagus. Modern, flexible medical instruments are
less likely to cause this type of damage than less advanced equipment. The risk
of perforation during a given procedure is extremely low.
Other, less common causes of esophageal perforation include:
- tumors in the throat
- ulcers in the throat caused by gastroesophageal reflux disease
- accidentally swallowing a foreign object, acid,
- physical trauma or injury to the neck
- violent vomiting
What Are the Symptoms of Esophageal Perforation?
Pain is the first symptom of esophageal perforation. You’ll
usually feel pain in the area where the hole is located. You may also feel
chest pain and have trouble swallowing.
Other symptoms of this condition
- increased heart rate
- rapid breathing
- low blood pressure
- vomiting, which may include blood
- pain or stiffness in your neck in the case of a
perforation in the cervical area
How Is Esophageal Perforation Diagnosed?
Your doctor will order an imaging test, such as an X-ray or CT
scan, to check for signs of esophageal perforation. These tests are used to look
in the chest for air bubbles and abscesses, which are sacs filled with pus. They
can also help your doctor see whether fluid has leaked out of your esophagus
and into your lungs.
How Is Esophageal Perforation Treated?
Your doctor must treat a perforation as quickly as possible to
prevent infection. The earlier you get treatment, the better. Ideally, you
should receive treatment within 24 hours of diagnosis.
The fluid that leaks out of the hole in your esophagus can become
trapped in the tissue between your lungs. This area is called the mediastinum. It’s
located behind your breastbone. The accumulation of fluid there can cause
breathing difficulties and lung infections.
A permanent stricture, or narrowing of the esophagus, can develop
if your esophageal perforation isn’t treated right away. This condition can
make swallowing and breathing more difficult.
Early treatment will include draining any fluid from your chest.
You’ll also need to take antibiotics to prevent or treat an infection. You won’t
be allowed to eat or drink anything by mouth until your treatment is completed.
Your doctor will give you antibiotics and fluids intravenously, or through an
IV. You may get nutrients through a feeding tube.
Closing the Perforation
Small holes in your cervical esophagus may heal on their own,
without surgery. This is more likely to occur if fluid flows back into the
esophagus and doesn’t leak into your chest. Your doctor will determine if you
need surgery within a day of your diagnosis.
Most people with a perforated esophagus do need surgery. This is
especially true if the hole is located in your chest or abdomen. During the
procedure, your surgeon will remove scar tissue from the area around the perforation
and then sew the hole shut.
Very large perforations may require the removal of a portion of
the esophagus. This procedure is called a partial esophagectomy. After the piece
is removed, the remaining section of the esophagus is reconnected to the
What Is the Outlook?
The outlook is good if you’re able to receive treatment quickly.
When esophageal perforation is treated within 24 hours, the chances of survival
are high. However, the survival rate goes down significantly if treatment is
delayed beyond the first 24 hours.
Go to the emergency room right away if you’ve recently had
esophageal surgery and you’re having trouble breathing or swallowing. You
should also go to the hospital if you have other symptoms of esophageal