Learn About Esophageal Perforation

What is the definition of Esophageal Perforation?

An esophageal perforation is a hole in the esophagus. The esophagus is the tube food passes through as it goes from the mouth to the stomach.

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What are the alternative names for Esophageal Perforation?

Perforation of the esophagus; Boerhaave syndrome

What are the causes of Esophageal Perforation?

When there is a hole in the esophagus, the contents of the esophagus can pass into the surrounding area in the chest (mediastinum). This often results in infection of the mediastinum (mediastinitis).

The most common cause of an esophageal perforation is injury during a medical procedure. However, the use of flexible instruments has made this problem uncommon.

The esophagus may also become perforated as the result of:

  • A tumor
  • Gastric reflux with ulceration
  • Previous surgery on the esophagus
  • Swallowing a foreign object or caustic chemicals, such as household cleaners, disk batteries, and battery acid
  • Trauma or injury to the chest and esophagus
  • Violent vomiting (Boerhaave syndrome)

Less common causes include injuries to the esophagus area (blunt trauma) and injury to the esophagus during surgery of another organ near the esophagus.

What are the symptoms of Esophageal Perforation?

The main symptom is pain when the problem first occurs.

A perforation in the middle or lower most part of the esophagus may cause:

  • Swallowing problems
  • Chest pain
  • Breathing problems
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What are the current treatments for Esophageal Perforation?

You may need surgery. Surgery will depend on the location and size of the perforation. If surgery is needed, it is best done within 24 hours.

Treatment may include:

  • Fluids given through a vein (IV)
  • IV antibiotics to prevent or treat infection
  • Draining of fluid around the lungs with a chest tube
  • Mediastinoscopy to remove fluid that has collected in the area behind the breastbone and between the lungs (mediastinum)

A stent may be placed in the esophagus if only a small amount of fluid has leaked. This may help avoid surgery.

A perforation in the uppermost (neck region) part of the esophagus may heal by itself if you do not eat or drink for a period of time. In this case, you will need a stomach feeding tube or another way to get nutrients.

Surgery is often needed to repair a perforation in the middle or bottom portions of the esophagus. Depending on the extent of the problem, the leak may be treated by simple repair or by removing the esophagus.

Who are the top Esophageal Perforation Local Doctors?
Highly rated in

Hamburg, HH, DE 

Gunnar Loske is in Hamburg, Germany. Loske is rated as an Elite expert by MediFind in the treatment of Esophageal Perforation. He is also highly rated in 2 other conditions, according to our data. His top areas of expertise are Esophageal Perforation, Secondary Peritonitis, Empyema, and Peritonitis.

Highly rated in
Thoracic Surgery

Loyola University Medical Center

Maywood, IL 

Richard Freeman is a Thoracic Surgeon in Maywood, Illinois. Dr. Freeman has been practicing medicine for over 32 years and is rated as an Elite doctor by MediFind in the treatment of Esophageal Perforation. He is also highly rated in 3 other conditions, according to our data. His top areas of expertise are Esophageal Perforation, Pleural Effusion, Parapneumonic Pleural Effusion, and Gastrointestinal Fistula. He is licensed to treat patients in Indiana and Illinois. Dr. Freeman is currently accepting new patients.

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Highly rated in

Imperial College London

London, ENG, GB 

Sheraz Markar is in London, United Kingdom. Markar is rated as an Elite expert by MediFind in the treatment of Esophageal Perforation. He is also highly rated in 17 other conditions, according to our data. His top areas of expertise are Esophageal Cancer, Esophageal Perforation, Renal Oncocytoma, and Appendectomy.

What is the outlook (prognosis) for Esophageal Perforation?

The condition can progress to shock, or even death, if untreated.

Outlook is good if the problem is found within 24 hours of it occurring. Most people survive when surgery is done within 24 hours. Survival rate goes down if you wait longer.

What are the possible complications of Esophageal Perforation?

Complications may include:

  • Permanent damage to the esophagus (narrowing or stricture)
  • Abscess formation in and around the esophagus
  • Infection in and around the lungs
When should I contact a medical professional for Esophageal Perforation?

Tell your provider right away if you develop the problem when you are already in the hospital.

Go to the emergency room or call 911 or the local emergency number if:

  • You have recently had surgery or a tube placed in the esophagus and you have chest pain, problems swallowing, or breathing.
  • You have another reason to suspect that you may have esophageal perforation.
How do I prevent Esophageal Perforation?

These injuries, although uncommon, are hard to prevent.

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What are the latest Esophageal Perforation Clinical Trials?
VAC Stent: A Prospective Feasibility Study for the Treatment of Gastrointestinal Leakage Through a Combination of Covered Nitinol Stent and Negative Pressure Wound Treatment
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International, Prospective, Multicenter Registry Designed to Collect Clinical Evidence for Endoscopic Vacuum Treatment Using Eso-SPONGE® for Anastomotic Leakage After Esophageal Resection or Iatrogenic or Spontaneous Esophageal Perforation.
What are the Latest Advances for Esophageal Perforation?
Individually designed fully covered self-expandable metal stents for pediatric refractory benign esophageal strictures.
Conservative treatment of Boerhaave's syndrome in an octogenarian complicated with late distal esophageal stenosis and successfully treated by stent placement.
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Boerhaave syndrome with double esophageal perforation. About a case.
What are our references for Esophageal Perforation?

Lambright E. Management of esophageal perforation. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:78-80.

Raja AS. Thoracic trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 38.