What Is an Esophageal Perforation?

Esophageal perforation is a rare disease that is dangerous once it occurs. It can cause serious complications such as fatal mediastinitis, mediastinal abscess, and aortic rupture, with a high mortality rate. There are two types of esophageal perforation: traumatic and idiopathic. The former is more common. The causes of traumatic esophageal perforation are esophageal foreign body, iatrogenic injury and corrosive injury. Idiopathic esophageal perforation is caused by severe vomiting caused by excessive drinking, constipation, childbirth, emetics, traumatic brain injury, etc., and inappropriate swallowing. . Almost all occur in the lower esophagus.

Basic Information

English name

esophageal perforation

Visiting department

Thoracic Surgery

Common locations

esophagus

Common causes

Caused by severe vomiting due to iatrogenic injury, foreign body in the esophagus, corrosive damage to the esophagus, excessive drinking, constipation, childbirth, emetic, traumatic brain injury

Common symptoms

Severe pain in the neck, chest, and abdomen, subcutaneous emphysema and mediastinal emphysema in the neck, etc.

Causes of esophageal perforation

Traumatic perforation

The etiology mainly includes iatrogenic injury, foreign body in esophagus, and corrosive injury. Mostly, esophagoscopy is performed blindly. The detection of foreign bodies, dilation and narrowing, or sharp foreign bodies in the esophagus (such as dentures with wire hooks, chicken bones, needles, nails, etc., or swallowing strong acids and alkalis) can cause esophageal perforation .

2. Idiopathic esophageal perforation

It is caused by severe vomiting caused by excessive drinking, constipation, childbirth, emetics, traumatic brain injury, etc., and inappropriate swallowing, etc., leading to a sharp rise in the internal pressure of the esophagus, causing the entire layer of the esophagus to rupture and perforate.

Clinical manifestations of esophageal perforation

1. Severe pain in the neck, chest, and abdomen, with forced posture, painful face, and difficulty swallowing.

2. Subcutaneous emphysema and mediastinal emphysema. It can extend to the face and groin in severe cases.

3. Symptoms of systemic septic infection.

4. Mediastinitis and abscesses, empyema, rupture of large blood vessels and other serious complications.

Esophageal perforation

1. Perform neck and chest radiography.

2. Esophageal lipiodol contrast, neck and chest CT scan.

3. Esophagoscopy. Esophagoscopy has important diagnostic value for esophageal injury caused by chest trauma and foreign body. When the esophageal angiography is negative, sometimes the situation of esophageal injury can be directly seen with esophagoscopy, and it can provide accurate positioning and understand the pollution. The results of esophagoscopy also help in the choice of treatment.

4. CT examination When the clinical suspicion of esophageal injury and the X-ray can not indicate the exact basis of diagnosis, further diagnosis also includes the choice of CT examination of the chest or abdomen. The diagnosis of esophageal perforation should be considered when the CT image shows the following signs:

(1) There is gas in the soft tissue of the mediastinum surrounding the esophagus.

(2) The pus cavity in the mediastinum or in the thorax is close to the esophagus.

(3) The inflated esophagus communicates with a cavity adjacent to the mediastinum or the mediastinum.

(4) Pleural effusion, especially left pleural effusion, further suggests the possibility of esophageal perforation. When any of the above is available, an esophageal angiogram should be performed to confirm the diagnosis and determine the location of the perforation, which is very important to guide the surgical treatment. In addition, the follow-up observation of the initial efficacy of patients with CT is also a particularly effective method.

Diagnosis of esophageal perforation

According to the history and clinical symptoms of severe neck and chest pain and dysphagia, combined with imaging examination can help diagnosis.

Esophageal perforation treatment

General treatment

Fasting, antibiotics to control infection, gastrointestinal decompression, and maintaining water and electrolyte balance.

2. Surgical treatment

One-stage perforation repair is suitable for patients within 12 to 24 hours after perforation; thoracotomy and mediastinal drainage is performed after abscess formation.

3. Idiopathic esophageal perforation

More aggressive surgical treatment should be adopted.