An esophageal perforation is a hole in the esophagus. The esophagus is the tube that food and liquids pass through on the way from your mouth to your stomach. Perforation of the esophagus is uncommon, but it’s a serious medical condition.
An esophageal perforation is usually repaired surgically. The condition can be life-threatening if it’s left untreated.
The esophagus is a long tube that connects your mouth to your stomach. It’s divided into three sections:
- The cervical area is the part of the esophagus inside your neck.
- The thoracic area is the part of the esophagus in your chest.
- The abdominal area is the part of the esophagus that leads to your stomach.
A perforation, or hole, can develop in any of these areas.
The most common cause of esophageal perforation is injury to the esophagus during another medical procedure.
Any medical instrument used in a diagnostic or treatment procedure can potentially perforate the esophagus. Modern, flexible medical instruments are less likely to cause this type of damage than less advanced equipment. The risk of perforation during a procedure is extremely low.
Other, less common causes of esophageal perforation include:
- tumors in the throat
- ulcers in the throat caused by gastroesophageal reflux disease (GERD)
- accidentally swallowing a foreign object, acid, or chemicals
- physical trauma or injury to the neck
- violent vomiting
Pain is the first symptom of esophageal perforation. You’ll usually feel pain in the area where the hole is located. You may also feel chest pain and have trouble swallowing.
Other symptoms of this condition include:
- increased heart rate
- rapid breathing
- low blood pressure
- vomiting, which may include blood
- pain or stiffness in your neck in the case of a perforation in the cervical area
Your doctor will order an imaging test, such as an X-ray or CT scan, to check for signs of esophageal perforation. These tests are used to look in the chest for air bubbles and abscesses. Abscesses are sacs filled with pus. The imaging tests can also help your doctor see if fluid has leaked out of your esophagus into your lungs.
Your doctor must treat a perforation as quickly as possible to prevent infection. The earlier you get treatment, the better your outcome will be. Ideally, you should receive treatment within 24 hours of diagnosis.
The fluid that leaks out of the hole in your esophagus can become trapped in the tissue between your lungs. This area is called the mediastinum. It’s located behind your breastbone. The accumulation of fluid there can cause breathing difficulties and lung infections.
A permanent stricture, or narrowing of the esophagus, can develop if your esophageal perforation isn’t treated right away. This condition can make swallowing and breathing more difficult.
Early treatment will include draining any fluid from your chest. You’ll also need to take antibiotics to prevent or treat an infection. You won’t be allowed to eat or drink anything until your treatment is completed. Your doctor will give you antibiotics and fluids through an intravenous (IV) line. You may get nutrients through a feeding tube.
Closing the perforation
Small holes in your cervical esophagus may heal on their own, without surgery. Self-healing is more likely to occur if fluid flows back into the esophagus and doesn’t leak into your chest. Your doctor will determine if you need surgery within a day of your diagnosis.
Most people with a perforated esophagus do need surgery, especially if the hole is located in the chest or abdominal areas. During the procedure, your surgeon will remove scar tissue from the area around the perforation and then sew the hole shut.
Very large perforations may require the removal of a portion of the esophagus. This procedure is called a partial esophagectomy. After the piece is removed, the remaining section of the esophagus is reconnected to the stomach.
The outlook is good if you’re able to receive treatment quickly. When esophageal perforation is treated within 24 hours, the chances of survival are high. However, the survival rate goes down significantly if treatment is delayed beyond the first 24 hours.
Go to the emergency room right away if you’ve recently had esophageal surgery and you’re having trouble breathing or swallowing. You should also go to the hospital if you have other symptoms of esophageal perforation.