Esophageal perforation is a hole in the esophagus. The esophagus is the tube that food and liquids pass through on the way from your mouth to your stomach. Perforation of the esophagus is uncommon, but it is a serious medical condition.
An esophageal perforation is most often repaired surgically. The condition can be fatal if left untreated.
The most common cause of esophageal perforation is injury to the esophagus during another medical procedure.
Any medical instrument used in a diagnostic or treatment procedure can potentially rupture the esophagus. Modern, flexible medical instruments are less likely to cause this type of damage than less advanced equipment. The risk of perforation during a given procedure is extremely low. An esophagogastroduodenoscopy, the most common cause of this condition, carries only a 0.03 percent risk of perforation (Mueller et al., 2011).
Other, even less common causes of esophageal rupture include:
- tumors in the throat
- ulcers in the throat caused by gastroesophageal reflux disease (GERD)
- accidentally swallowing acid or chemicals
- physical trauma or injury to the neck
- cervical: the section of the esophagus inside your neck
- thoracic: the part of the esophagus in your chest
- abdominal: the area of the esophagus leading into your stomach
A hole can develop in any of these areas.
Pain is the first symptom of esophageal perforation. You will usually feel pain in the area where the hole is located. You may also feel chest pain and have trouble swallowing.
Other symptoms of the condition include:
- rapid heart rate
- rapid breathing
- vomiting (sometimes vomiting blood)
- pain or stiffness in the neck (in the case of a perforation in the cervical area)
Your doctor will order an X-ray or computed tomography (CT) imaging scan of your neck and chest. This is in order to diagnose esophageal perforation.
Your doctor must treat a perforation as quickly as possible to prevent infection. The earlier you receive treatment, the better. Ideally, you should receive treatment within 24 hours of diagnosis.
Fluid that leaks out of the hole in the esophagus can become trapped in the tissue between your lungs. This area is called the “mediastinum” and is located behind the breastbone. The collection of fluid can cause breathing difficulties and lung infections.
Stricture, or permanent narrowing of the esophagus, can develop if treatment for esophageal perforation is delayed. Strictures can make swallowing and breathing more difficult.
Early treatment will include draining any fluid from your chest. You’ll also take antibiotics to prevent or treat infection. You will not be allowed to eat or drink anything by mouth until your treatment is completed. Your doctor will give you antibiotics and fluids intravenously. You may get nutrients from a feeding tube.
Closing the Perforation
Small holes in the cervical esophagus may heal on their own, without surgery. This is more likely if fluid does not leak into the chest, but flows back into the esophagus (AJRCCM, 2002). Your doctor will determine if surgery is necessary within a day of diagnosis.
Most patients with a perforated esophagus require surgery. This is especially true if the hole is located in the chest or abdomen. Your surgeon will remove scar tissue from around the open area and sew the hole shut. Very large perforations may require removing a portion of the esophagus. This procedure is called a partial esophagectomy. The remaining section of esophagus is then reconnected to the stomach.
Outlook is good for patients who are able to get treatment promptly.
Recovery rates vary depending on which part of the esophagus is affected. According to research, survival rates for cervical perforations treated surgically are around 94 percent. Survival rates for abdominal perforations are 71 percent. Thoracic perforation survival rates are approximately 66 percent (AJRCCM, 2002).
Unfortunately, survival rates can drop to around 50 percent if treatment is delayed beyond the first 24 hours (NIH, 2010).