Esophageal Perforation

1 May

Common Causes:

-Iatrogenic causes are the most common (endoscopy, radiation, dilatations, variceal treatment)

-Boerhaave Syndrome

-Foreign body

-Trauma

-Tumor

 

Symptoms:

-Acute, severe chest pain usually most common

-Pain can radiate to the neck, abdomen, back, shoulders

-Symptoms are usually worsened with swallowing

 

Exam findings:

Cervical subcutaneous emphysema is common in upper (cervical) esophageal perforations

-Lower esophageal perforations often show no mediastinal emphysema

Hamman Crunch= Air in the mediastinum that is being moved by the beating heart

-Patients often develop pleural effusions

 

Boerhaave Syndrome

-Full thickness esophageal perforation

-Caused by sudden forceful rise in the intraesophageal pressure such as with sudden forceful emesis

-coughing, straining, seizures, and childbirth have all also been associated with it

-More often associated with distal esophageal perforations

 

Effects:

-Mediastinitis pneumonitis can lead to shock

-Proximal perforations are generally not as severe as distal perforations

-High mortality rate

 

Treatment:

Treat the shock

Broad spectrum antibiotics

Thoracic surgery consultation

 

Submitted by Joey Grover.

Sources: Tintinalli’s Emergency Medicine, 7th Edition; Image 

 

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