Perforation (Hole) in Esophagus

What is Esophageal Perforation?

Perforation of the esophagus means that there has been an injury to the esophagus leading to leakage of the contents into the surrounding organs. It must be detected and treated early with surgical intervention. If untreated can lead to serious conditions and complications. Since the esophagus connects from the mouth and into the stomach, it is quite long, perforation can lead to involvement of three sites: cervical – inside the neck, thoracic – inside the chest and abdominal – inside the stomach area.

Causes

Some of the common causes of esophageal injury and perforation are:

  • Ingestion of a sharp object: Lacerations, tissue destructions, penetrating injury and iatrogenic injury can be formed on the esophagus as the object is swallowed
  • Forceful vomiting
  • Ingestion of harmful chemicals: Intake of abrasive, alkaline or acidic chemicals and drugs can harm the esophagus
  • Physical trauma: When there is direct injury to the throat due to an accident

Symptoms
  • Severe chest pain
  • Retching and vomiting sometimes with blood
  • Rapid and shallow breathing
  • Subcutaneous emphysema- air gets beneath the layer of the skin
  • Rapid heart rates
  • Dysphagia or difficulty in swallowing

Diagnosis Tests
  • CT Scan: Chest CT scan may be conducted to diagnose cancer or ulcer in the esophagus
  • Chest X-ray: The patient swallows a contrast material to determine the area or site of rupture and injury to the esophagus.
  • Endoscopy: It is done to determine the expanse of injury and perforation whether transmural or mucosal, to the esophagus.
Treatments
  • Treatment depends upon the cause of the perforation.
  • Emergency surgery with closure of the perforation and coverage with muscle or omentum or stomach is needed.
  • In some cases, removal of the esophagus might be needed.
  • In mild cases, placing metal stent within the esophagus might solve the problem.