Esophageal Perforation
A tear or hole in the esophageal wall — a surgical emergency.
Overview
Esophageal perforation is a tear or hole in the food pipe, allowing saliva, food, and digestive juices to leak into the chest or abdomen. It is a surgical emergency with high risk if not treated promptly. Causes include vomiting, medical procedures, swallowed foreign bodies, or injury. Rapid diagnosis and treatment are critical.
Causes
- Forceful vomiting (Boerhaave syndrome)
- Complication of endoscopy or dilatation
- Swallowed foreign body or sharp object
- Trauma
- Advanced esophageal cancer
- Corrosive injury
Risk Factors
- Recent esophageal procedures
- Esophageal disease (strictures, cancer)
- Severe vomiting
- Foreign body ingestion
Symptoms
Diagnosis
- CT chest and abdomen with contrast
- Contrast swallow study
- Chest X-ray
- Upper GI endoscopy
- Blood tests showing infection
Treatment Options
Surgical Treatment
Treatment depends on the size, location, and timing of the perforation. Early, contained perforations may be managed with endoscopic stenting or clipping and drainage. Larger or delayed perforations require surgical repair and washout of the chest or abdomen. Dr. Bhagat manages these emergencies with a focus on source control, drainage, and nutritional support.
Recovery
Recovery is often prolonged, requiring a hospital stay of one to several weeks depending on severity. Nutrition is maintained via feeding tube until the esophagus heals. Early treatment dramatically improves outcomes.
Prevention
- Careful technique during endoscopic procedures
- Prompt removal of swallowed foreign bodies
- Avoiding forceful vomiting where possible
- Early evaluation of severe chest pain after vomiting or endoscopy
Frequently Asked Questions
Why is esophageal perforation so serious?
Can it heal without surgery?
Expert Consultation Available
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