Esophageal perforations are one of the most traumatic conditions treated by thoracic surgeons at Cardiac Vascular and Thoracic Surgery Associates.
An esophageal perforation occurs when there is a hole in the esophagus, the tube which passes food from the mouth into the stomach. While rare, esophageal perforations can be life threatening. They are generally caused by tumors, violent vomiting, trauma or swallowing a foreign object.
The first symptom of an esophageal perforation is usually pain, followed by rapid breathing, an increased heart rate, low blood pressure and fever. Depending on the location of the perforation, patients may also experience neck pain or stiffness, difficulty swallowing, shortness of breath and chest pain.
The diagnosis is typically by history, confirmed by chest X-ray, CT scan and or barium swallow test. These tests look for air in the soft tissues of the chest, outside the lungs or fluid outside the lungs.
In almost all patients, surgery is performed within the first 24 hours after the perforation occurs. The goal of surgery is to repair the perforation by closing the hole it created. In certain circumstances surgery to repair the hole may not be prudent in which case an esophageal stent may be used or in dire circumstances the esophagus may need to be diverted to the skin surface to prevent further contamination of the vital, sterile structures within the chest. In these circumstances, a surgically placed feeding tube in the abdomen is used for nutritional supplementation until the perforation is healed or fixed.
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