Esophageal tears/Injury: Connecting the pharynx to the stomach, the esophagus is a fibromuscular tube that spans three sections of the body: the neck (cervical), the chest (thoracic), and the stomach (abdominal). Esophageal tears/injury are caused by damage to the esophageal wall resulting from a mucosal tear, perforation, or rupture. Occasionally, esophageal tears can occur in 3 different areas of the body, thereby causing the presentation of symptoms to vary. These diverse symptoms can delay the time of final diagnosis and treatment. The mortality rate is 50%. Frequency of perforations in the United States are 3:100,000. Fifty-four percent of most common esophageal injuries are intrathoracic perforations, followed by cervical esophagus perforations at 27%, and intra-abdominal perforations at 19%.
There are many causes of esophageal tears; however, for the purpose of this blog, I will continue to focus on personal injuries such as iatrogenic perforations, which are a group of perforations caused by instrumentation for diagnostic or therapeutic purposes (endoscopy, pneumatic dilation, hemostasis, stent placement, foreign body extraction, cancer palliation, and endoscopic ablation). Other causes of esophageal tears include blunt abdominal trauma, cardiopulmonary resuscitation (CPR), and gunshot or stab wounds. Depending on the location and severity of the injury, a tear will allow the upper gastrointestinal contents to leak from the lumen into the soft tissue of the neck, the mediastinum and pleural space, and the peritoneal cavity. If tears are left untreated, then infections will occur in the soft tissue of the neck, the mediastinum (mediastinitis), the pleural space (pleuritis), and the peritoneal cavity (peritonitis), followed by sepsis and possible death. These types of injuries are a medical emergency, so prognosis is based on causes, site of perforation, time to diagnosis, and treatment.
Signs and symptoms of an esophagus tear or injury are pain and tenderness in the neck, difficulty swallowing, shortness of breath, rapid breathing, fever, chest pain, abdominal pain, bloody sputum, wheezing, and hoarseness. Diagnostic tests performed to identify esophageal injuries may include X-rays, computed tomography (CT) scans, and an endoscopy.
Treatment depends on severity, and prognosis is good if treatment is received quickly within 24 hours. Prognosis decreases the longer treatment is delayed.
References
Ali Nawaz Khan, A. N., Macdonald, S., Coombs, B.D., Dachman, A. H., Lin, E. C., & Amin, Z. (2018). Esophageal Tear Imaging. https://emedicine.medscape.com/article/375584-overview
Cedars-Sinai. (2020). Esophageal Rupture. https://www.cedars-sinai.org/health-library/diseases-and-conditions/e/esophageal-rupture.html
Jaojormami. (2020). [Image]. Esophageal cancer in woman. https://www.shutterstock.com/image-photo/esophageal-cancer-woman-she-touching-her-1575905248
Kassem, M. M., & Wallen, J. M. (2020). Esophageal Perforation and Tears.
https://www.ncbi.nlm.nih.gov/books/NBK532298/