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Esophageal RuptureAka: Esophageal Perforation, Boerhaave's Syndrome

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  1. Pathophysiology
    1. Lower esophagus lacks serosal covering
    2. Following rupture:
      1. Only mediastinal pleura contains esophageal contents
    3. Pressure gradient changes with respirations
  2. Causes
    1. Esophageal Cancer
    2. Esophageal Foreign Body
    3. Severe Retching or Vomiting (Mallory-Weis Tear)
  3. Symptoms
    1. Melena
    2. Vomiting
      1. Retching
      2. Hematemesis
    3. Chest Pain
      1. Follows Retching
      2. Retrosternal pain radiates to back or epigastrium
      3. Pain increases with swallowing or neck movement
  4. Signs
    1. Sudden collapse and patient appears acutely ill
      1. Shock
      2. Fever
      3. Tachycardia
      4. Prostration
    2. Signs develop only gradually
      1. Subcutaneous Emphysema
      2. Mediastinal air
      3. Hamman's Crunch
      4. Pleural Fluid
  5. Labs
    1. Complete Blood Count (CBC)
      1. Leukocytosis
  6. Diagnosis
    1. Chest XRay
      1. Anterior displacement of trachea
      2. Mediastinal air (Mediastinal Emphysema)
      3. Pleural Effusion
      4. Wide mediastinum
      5. Pneumothorax
    2. Esophagram (Gastrografin or dilute barium)
    3. Endoscopy (false negatives not uncommon)

Esophageal Perforation (C0014860)

Definition (MSH)An opening or hole in the ESOPHAGUS that is caused by TRAUMA, injury, or pathological process.
Definition (NCI)The presence of a hole or other type of opening in the esophageal wall through which the contents of the esophagus can pass into the mediastinum. The most common cause of esophageal perforation is injury during a medical procedure such as esophagoscopy or placement of a naso-gastric tube; and pathologic process such as neoplasm or gastric reflux with ulceration. Less common causes include injuries from penetrating or blunt trauma or injury to the esophagus during an operation on another organ, mechanical problem such as violent retching or vomiting; ingestion of a foreign body or caustic agents. The condition often results in infection of the mediastinum and mediastinitis.
ConceptsDisease or Syndrome (T047)
ICD9530.4
EnglishEsophageal Perforation, Esophageal Perforations, ESOPHAGUS PERFORATION, OESOPHAGEAL PERFORATION, PERFORATION ESOPHAGUS, Perforation Of Esophagus, Perforation of oesophagus
Spanishperforación del esófago, perforacion del esofago
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Rupture of esophagus (C0281839)

ConceptsDisease or Syndrome (T047)
ICD9530.4
EnglishBursting injury of esophagus, Bursting injury of oesophagus, Disruption of esophagus, Disruption of oesophagus, Esophageal Rupture, Rupture of esophagus, Rupture of oesophagus
Spanishdisrrupción esofágica, disrrupcion esofagica, ruptura esofágica, ruptura esofagica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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