Gastroenterology Book

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Esophageal Rupture

Aka: Esophageal Rupture, Esophageal Perforation, Boerhaave's Syndrome, Esophageal Tear
  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)
    4. Traumatic Injury
      1. Penetrating chest trauma
      2. Blunt force to left chest, Sternum or epigastrium
  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 Effusion
  5. Labs
    1. Complete Blood Count (CBC)
      1. Leukocytosis
  6. Diagnosis
    1. Nasogastric Tube
      1. Aspirate with bloody fluid
    2. Chest XRay
      1. Anterior displacement of trachea
      2. Mediastinal air (Mediastinal Emphysema)
        1. Pathognomonic of Esophageal Rupture
      3. Pleural Effusion
      4. Wide mediastinum
      5. Pneumothorax
        1. When trauma-related it is often left sided and without Rib Fracture
        2. Chest Tube will show continued air leak and particulate matter
    3. Esophagram (Gastrografin or dilute barium)
    4. Gastroscopy (false negatives not uncommon)
  7. Management
    1. Emergent surgical intervention
      1. Survival rates are best with the earliest interventions (within hours of onset)
      2. Wide mediastinal drainage and esophageal wall repair

Rupture of esophagus (C0281839)

Concepts Injury or Poisoning (T037)
ICD10 K22.3
SnomedCT 235626005
English ESOPHAGUS, RUPTURE, Esophageal Rupture, esophagus rupture, oesophageal rupture, rupture esophagus, esophageal rupture, rupture of esophagus, Oesophageal rupture, Esophageal rupture, Bursting injury of esophagus, Bursting injury of oesophagus, Disruption of esophagus, Disruption of oesophagus, Rupture of oesophagus, Rupture of esophagus (disorder), esophagus; rupture, rupture; esophagus, Rupture of esophagus
Italian Rottura esofagea, Rottura dell'esofago
French Rupture oesophagienne, Rupture de l'oesophage
Portuguese Rutura do esófago, Ruptura esofágica
Spanish Rotura esofágica, disrrupción esofágica, ruptura esofágica (trastorno), ruptura esofágica, Ruptura de esófago
Japanese 食道破裂, ショクドウハレツ
Czech Ruptura jícnu
Hungarian Oesophagealis szakadás, Oesophagus ruptura
Dutch oesofagus; ruptuur, ruptuur; oesofagus, slokdarmruptuur
German Speiseroehrenriss
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Esophageal Perforation (C0014860)

Definition (NCI) A disorder characterized by a rupture in the wall of the esophagus.
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.
Definition (MSH) An opening or hole in the ESOPHAGUS that is caused by TRAUMA, injury, or pathological process.
Concepts Disease or Syndrome (T047)
MSH D004939
ICD9 530.4
ICD10 K22.3
SnomedCT 155676000, 23387001
English Esophageal Perforations, Perforation, Esophageal, Perforations, Esophageal, PERFORATION ESOPHAGUS, ESOPHAGEAL PERFORATION, ESOPHAGUS PERFORATION, ESOPHAGUS, PERFORATION, OESOPHAGEAL PERFORATION, esophageal perforation, esophageal perforation (diagnosis), Perforation of oesophagus (disorder), Esophageal perforation, Perforation esophagus, Oesophageal perforation, Perforation Of Esophagus, ESOPHAGUS, PERFORATION OF, PERFORATION OF ESOPHAGUS, Esophageal Perforation [Disease/Finding], esophagus perforation, perforation esophagus, oesophageal perforation, perforation of esophagus, Perforation oesophagus, Perforation of esophagus, Perforation of oesophagus, Perforation of esophagus (disorder), esophagus; perforation, perforation; esophagus, Esophageal Perforation
Portuguese PERFURACAO ESOFAGICA, Perfuração do esófago, Perfuração esofágica, Perfuração Esofágica
German OESOPHAGUSPERFORATION, Perforation des Oesophagus, Oesophagusperforation, Ösophagusperforation
Italian Perforazione esofagea, Perforazione dell'esofago
Dutch perforatie oesofagus, slokdarmperforatie, perforatie van slokdarm, oesofagus; perforatie, perforatie; oesofagus, Perforatie van slokdarm, oesofagusperforatie, Oesofagusperforatie, Perforatie, oesofagus-, Perforatie, slokdarm-, Slokdarmperforatie
Spanish Perforacion de esófago, Perforation of esophagus, Perforation of oesophagus, ESOFAGO, PERFORACION, perforación del esófago (trastorno), perforación del esófago, Perforación de esófago, Perforación del Esófago, Perforacion del Esofago
Japanese 食道穿孔, ショクドウセンコウ
Swedish Esofagusperforation
Czech ezofágus - perforace, Perforace jícnu, Jícnová perforace
Finnish Ruokatorven perforaatio
Russian PISHCHEVODA PERFORATSIIA, ПИЩЕВОДА ПЕРФОРАЦИЯ
French PERFORATION DE L'OESOPHAGE, Perforation de l'oesophage, Perforation oesophagienne, Rupture de l'oesophage
Korean 식도의 천공
Polish Perforacja przełyku, Przedziurawienie przełyku
Hungarian Nyelőcső perforatio, Oesophagus perforatio, Nyelőcső perforatiója, Oesophagealis perforatio
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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