Oesophageal rupture

Oesophageal rupture is a medical condition characterized by a tear or rupture in the esophagus, the tube that carries food from the mouth to the stomach. This condition is considered a medical emergency and requires prompt diagnosis and treatment to prevent potentially life-threatening complications. Oesophageal rupture can occur spontaneously, as in Boerhaave syndrome, or as a result of traumatic injury, medical procedures, or ingestion of caustic substances.

Causes

Oesophageal rupture can be caused by several factors, including:

• Spontaneous rupture (Boerhaave syndrome): This is a rare condition that can occur after forceful vomiting or retching.
• Iatrogenic causes: Damage to the esophagus during medical procedures such as endoscopy, esophageal dilation, or surgery.
• Traumatic causes: Blunt or penetrating trauma to the chest or abdomen that damages the esophagus.
• Ingestion of caustic substances: Swallowing corrosive chemicals can cause severe damage to the esophagus and potentially lead to rupture.

Symptoms

Symptoms of oesophageal rupture may include:

• Severe chest pain, often described as tearing or ripping, that may radiate to the back
• Vomiting or retching followed by severe chest pain (in cases of Boerhaave syndrome)
• Difficulty swallowing (dysphagia)
• Shortness of breath (dyspnea)
• Fever
• Rapid heart rate (tachycardia)
• Low blood pressure (hypotension)
• Subcutaneous emphysema (air present under the skin)

Diagnosis

Diagnosis of oesophageal rupture typically involves a combination of medical history, physical examination, and diagnostic tests, including:

• Chest X-ray: May show air in the mediastinum (the central compartment of the thoracic cavity) or pleural effusion.
• Computed tomography (CT) scan: Provides detailed images that can help identify the location and extent of the rupture.
• Esophagogram with water-soluble contrast: A specialized X-ray study that can reveal the presence of a leak from the esophagus.
• Endoscopy: Allows direct visualization of the esophagus and can identify the site of rupture or injury.

Treatment

Treatment of oesophageal rupture aims to close the tear, prevent infection, and manage any resulting complications. Treatment options may include:

• Surgical repair: The standard treatment for most cases of oesophageal rupture, involving suturing the tear or performing a patch repair.
• Non-surgical management: In selected cases, especially in patients with high surgical risk, treatment may involve antibiotics, intravenous fluids, and nutritional support while closely monitoring the patient for signs of infection or worsening condition.
• Endoscopic treatments: For certain types of tears, endoscopic techniques such as clipping or stenting may be used to seal the rupture.

Complications

If not treated promptly, oesophageal rupture can lead to serious complications, including:

• Mediastinitis: Infection of the mediastinum, which can be life-threatening.
• Sepsis: A severe, body-wide response to infection.
• Pleural effusion: Accumulation of fluid in the pleural space surrounding the lungs.
• Empyema: Accumulation of pus in the pleural space.
• ARDS (Acute Respiratory Distress Syndrome): A severe form of respiratory failure.

Prognosis

The prognosis for oesophageal rupture depends on the cause, location, and extent of the rupture, as well as the timeliness and effectiveness of treatment. Early diagnosis and prompt, appropriate treatment are crucial for improving outcomes and reducing the risk of complications.

‎