Esophageal perforation

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Causes

  1. Iatrogenic
  2. Boerhaave syndrome
  3. Trauma
    1. Penetrating
    2. Blunt (rare)
  4. Caustic ingestion
  5. Foreign body (includes pill esophagitis)
  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. PE
  3. Aortic catastrophe
  4. Acute abdomen
  5. Peptic ulcer disease

Treatment

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

Disposition

See Also

Source

Tintinalli

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