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.
Perforation of the esophagus; Boerhaave syndrome
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:
Less common causes include injuries to the esophagus area (blunt trauma) and injury to the esophagus during surgery of another organ near the esophagus.
The main symptom is pain when the problem first occurs.
A perforation in the middle or lower most part of the esophagus may cause:
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:
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.
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.
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.
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.
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.
Complications may include:
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:
These injuries, although uncommon, are hard to prevent.
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.