Esophageal Rupture - Causes and Signs of Esophageal Rupture

Rupture (perforation) of the esophagus can be caused by trauma or spontaneous. Spontaneous rupture of the esophagus is also known as banquet esophagus or Boerhaave syndrome. This is a special type of injury in which the walls of a completely healthy esophagus rupture due to intraesophageal pressure. In gastroenterology, esophageal perforation and spontaneous rupture of the esophagus are distinguished, first of all, by the causes of occurrence.

Rupture of the esophagus can be complete or partial. In the first case, the entire thickness of the organ wall is damaged, and in the second - one or more of its membranes.

Causes

If we talk about perforation of the esophagus, it can occur during various medical and diagnostic procedures: tracheal intubation, tracheostomy, cardiodilation, surgical interventions in the neck, sternum, abdomen and other medical manipulations. Also, ulcers and tumors, foreign bodies, chemical burns can lead to esophageal rupture. It is also possible to damage the esophageal wall with penetrating wounds in the neck or chest area.

If the pressure inside the esophagus increases, a spontaneous rupture of the organ wall can occur. The main cause of this condition is severe vomiting, which can occur when drinking large amounts of alcohol or overeating. Most often, esophageal rupture occurs when a person tries to forcibly restrain the urge to vomit. That is why the pathological condition is called "banquet esophagus".

In rare cases, spontaneous rupture of the esophagus occurs under the following circumstances:

• straining during childbirth or lifting weights;
• severe cough;
• blunt abdominal trauma;
• epileptic seizure.

The risk group includes males over sixty years of age.

Symptoms of esophageal rupture

With esophageal rupture, the following clinical picture is usually observed:

• during severe vomiting, a very strong, sharp pain in the epigastric region and sternum suddenly occurs. Sometimes the pain radiates to the lower back or left shoulder;
• cold sweat appears;
• the skin turns pale;
• breathing becomes intermittent, shallow, difficult;
• pulse quickens;
• chest pain increases during swallowing;
• emphysema of the neck appears - an accumulation of air in the subcutaneous fatty tissue.

Diagnostics

The diagnosis of esophageal rupture considers the anamnesis data, as well as a number of instrumental and physical examinations:

• plain chest radiography;
• abdominal X-ray;
• esophageal X-ray using water-soluble contrast agent;
• if necessary, pharyngoscopy, mediastinoscopy, esophagoscopy are prescribed.

During the diagnosis, it is very important to exclude other pathologies that may have similar symptoms: myocardial infarction, peptic ulcer, attack of acute pancreatitis, etc. For this, if necessary, an ultrasound examination of the aorta, echocardiography, ultrasound examination of the pleural cavities, laparoscopy and other studies can be performed.

Treatment of esophageal rupture

As a rule, treatment for esophageal rupture is possible only by surgery, although conservative therapy may be prescribed for fresh injuries to the laryngeal part of the esophagus. Also, surgery can be avoided in case of an incomplete rupture of the esophageal wall. In such situations, the patient is necessarily hospitalized, painkillers and antibacterial drugs are prescribed, and oral nutrition is completely excluded. If the patient's health deteriorates, urgent surgical intervention is performed.

If the patient is diagnosed with a rupture of the cervical esophagus, a cervical mediastinotomy is performed and a double-lumen drainage is installed. If the thoracic esophagus is damaged, if no more than 24 hours have passed since the rupture, surgeons perform a thoracotomy, the defect is sutured and covered with a pleural flap. If more time has passed since the injury, the esophagus is not sutured, but palliative measures are taken:

• gastrostomy;
• pleural drainage;
• mediastinotomy;
• esophagostomy, etc.

Prevention

Prevention of esophageal wall damage is based on caution when performing any endoscopic procedures, surgical manipulations and any medical interventions. To prevent spontaneous rupture of the organ, overeating and alcohol abuse, heavy and sudden physical exertion should be avoided.