Esophageal Perforation

By Charbel on Feb 19, 2011 | In Health, What To Order When:, GASTROINTESTINAL, Esophagus

Esophageal Perforation
Presenting Signs and Symptoms

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Sudden epigastric pain radiating to the shoulder blades after vomiting, retching, or even hiccups (especially after heavy drinking)

Gravely ill appearance with pallor, sweating, tachycardia, and often shock
Common Causes

Boerhaave's syndrome

Penetrating trauma

Complication of endoscopy
Approach to Diagnostic Imaging

1.
Plain chest radiograph

Initial imaging study for detecting air dissecting within the mediastinum and soft tissues, often with pleural effusion or hydropneumothorax

2.
Barium swallow

May demonstrate extravasation through a transmural perforation
Caveat: Water-soluble contrast material must be used first (since barium cannot be cleared from the mediastinum); if the patient cannot protect the airway, use iso-osmolar, non-ionic oral contrast material; if no gross extravasation is shown, use barium (a better contrast agent) to exclude a small leak.

3.
Computed tomography

Preferred study for defining the extent of an inflammatory process in the mediastinum secondary to an esophageal perforation

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