Esophageal perforation

Causes

1. Iatrogenic
2. Boerhaave syndrome
3. Thoracic Trauma
   1. Penetrating
   2. Blunt (rare)
4. Caustic ingestion
5. Foreign body
   1. Bone, button battery
6. Infection (rare)
7. Tumor
8. Aortic pathology
9. Barrett esophagus
10. Zollinger-Ellison syndrome

Diagnosis

History

• Pain
  • Acute, severe, unrelenting, diffuse
  • May be localized to chest, neck, abdomen; radiate to back and shoulders
• Dysphagia
• Dyspnea
• Hematemesis

Physical Exam

• Cervical subcutaenous emphysema
• Mediastinal emphysema
  • Takes time to develop
  • Absence does not rule out perforation

Imaging

• CXR
• CT chest
• Emergent endoscopy

DDx

1. ACS
2. Pulmonary Embolism
3. Aortic catastrophe
4. Acute abdomen
5. Peptic Ulcer Disease

Management

1. Volume resuscitation
2. Broad-spectrum IV Abx
3. Emergent surgical consultation

Source

Tintinalli