Oesophageal rupture

Question 1

What are 2 possible mechanisms for oesophageal perforation?

Answer 1

1. Spontaneous: Boerhaave syndrome, deceleration injury
2. Penetrating: intra and extraluminal

Question 2

What is Boerhaave syndrome?

Answer 2

• barogenic injury resulting from a sharp increase in the intraluminal pressure against a closed cricopharyngeus.
• most commonly associated with emesis with incomplete cricopharyngeal relaxation
• perforation typically occurs at weakest point in oesophagus, usually left lower oesophageal below diaphragm

Question 3

What are 2 key risk factors for Boerhaave syndrome?

Answer 3

1. Alcoholism
2. Overindulgence in food and drink

Question 4

What are 8 clinical features of oesophageal perforation?

Answer 4

1. Subcutaneous emphysema
2. Retrosternal or pleuritic chest pain
3. Fever
4. Dysphagia
5. Odynophagia
6. Hoarseness
7. Cervical tenderness
8. Sepsis

Question 5

What are 3 key investigations to perform in suspected oesophageal perforation?

Answer 5

1. CXR
2. Contrast oesophagogram
3. CT

Question 6

What are 3 findings likely to be present on a chest x-ray in oesophageal perforation?

Answer 6

1. Pneumomediastinum
2. Pneumothorax
3. Pleural effusions

Question 7

What are 2 benefits of a contrast oesophagogram?

Answer 7

1. high sensitivity
2. tolerated well

Question 8

What are 5 possible features of oesophageal rupture on CT?

Answer 8

1. Wall discontinuity
2. Contrast extravasation
3. Pneumomediastinum
4. Oesophageal thickening
5. Mediastinal fluid collections

Question 9

What is the aim of management of oesophageal rupture within 12 hours?

Answer 9

optimally repaired rupture with drainage of collections

Question 10

What are 4 aspects of the management of oesphageal rupture?

Answer 10

1. Primary closure discouraged
2. Generous drainage
3. Diversion of oesophagus
4. Antibiotics