Esophageal perforation Flashcards
first test to evaluate spontaneous esophageal rupture
CXR - look for mediastinal or free peritoneal air, if negative need CT chest or esophagram
see pleural effusion on left side
If CXR is negative for mediastinal air and free peritoneal air and concerned for spontaneous esophageal rupture, what test to order next?
CT or esophagram (with gastrografin) to look for free perforation - helps surgeon understand where the leak is.
esophageal free perforation is seen on imaging. what to do next?
surgery is first line treatment and endoscopic stent placement in select cases
contained esophageal perforation seen on imaging
what to do next?
nasogastric suction
IV broad spectrum abx
TPN
abscesses and effusions need drainage
what causes spontaneous esophageal rupture?
Boerhaave’s syndrome from prolonged nausea and vomiting and acute rise in intraesophageal pressure combined with negative pressure - can lead to transmural esophageal tear and acute barotrauma
Spontaneous esophageal rupture mortality rate
20% due to infectious complications of empyema mediastinitis and septic shock
presentation of spontaneous esophageal rupture
vomiting retching, chest and upper abdominal pain with rapid progression to odynophagia, fever, dyspnea and septic shock.
imaging findings of spontaneous esophageal rupture?
see pneumomediastinum or pleural effusions which develops in hours on left side
can see retrocardiac air shadow or mediastinal area - can be overlooked or thought to be a hiatal hernia
what may be seen on physical exam with spontaneous eophageal rupture?
subcutaneous emphysema (30% of time)
pleural fluid analysis of esophageal rupture
pleural fluid analysis will show exudative, low pH and very high amylase >2500.
classic triad of esophageal rupture
forceful vomiting, chest pain and subcutaneous emphysema
get CXR and esophagram and call surgeons
