Esophageal Rupture

Esophageal rupture is a dangerous condition. Early symptoms can be nonspecific, so less than half are correctly diagnosed within the first 12 hours, after which time mortality is 25%. Mortality exceeds 60% after 24 hours.

Spontaneous esophageal rupture, or Boerhaave's syndrome, occurs when esophageal pressure is significantly increased (e.g., vomiting against a closed glottis). This usually creates a small, vertical tear of the lower esophagus (90%), on the left side (90%). Other phenomena reported to induce an esophageal tear include hiccups, childbirth, weight lifting, forceful swallowing, and blunt trauma. The causes of esophageal rupture include Boerhaave's syndrome (15%), trauma (20%), foreign bodies (15%), and iatrogenic causes (50%).

Symptoms may mimic and are often misdiagnosed as perforated ulcer, acute MI, dissecting aortic aneurysm, pulmonary embolism, acute pancreatitis, spontaneous pneumothorax, lung abscess, biliary colic, mesenteric vascular occlusion, incarcerated diaphragmatic hernia, and other entities. Although esophageal rupture is most common after age 50 and is rare in children, it can occur at any age.

Causes

All cases of esophageal rupture are related to insertion of tubes or instruments into the esophagus during medical procedures. Severe trauam may tear the esophagus. A foreign body which has been swallowed may penetrate the wall of the esophagus. Swallowing corrosive chemicals will damage. Forceful vomiting may rarely tear a portion of the esophagus. Ulcers within the esophagus or cancers within the esophagus may eventually erode through its wall.

Latrogenic etiologies rupture predominate the causes

• Instrumentation modalities commonly such as including endoscopy, sclerotherapy, variceal ligation, pneumatic dilation, bougienage, and laser treatment.
• Placement of endotracheal, nasogastric, and Blakemore tubes represent less common iatrogenic causes.

Symptoms

• Chest pain +++++, commonly severe, acute, and pleuritic that is generally left sided and preceded by vomiting
• Abdominal or back pain
• Dyspnea
• Dysphagia
• Nausea

Signs

• Vital signs may be normal early in the Course of this disease but progress to shock.
• Tachypnea
• Fever
• Hamman's sign ++
• Chest examination provides evidence of pleural effusion.
• Subcutaneous emphysema +++
• Meckler's triad of vomiting, lower chest pain, and subcutaneous emphysema may be present.

Treatment

• For the treatment of esophageal rupture, you can used Standard therapy and therapy including the several factors such as Parenteral nutritional support, Nasogastric suction, Broad-spectrum antibiotics, Narcotic analgesics.
• You can also used the conservative therapy. In which therapy, it include perforation in the mediastinum and the visceral pleura, drainage of perforation into the esophagus.