An esophageal perforation is a hole in the esophagus. The esophagus is the tube food passes through as it goes from the mouth to the stomach.
The contents of the esophagus can pass into the surrounding area in the chest (mediastinum), when there is a hole in the esophagus. This often results in infection of the mediastinum (mediastinitis).
The most common cause of an esophageal perforation is injury during a medical procedure. However, the use of flexible instruments has made this problem rare.
Less common causes include injuries to the esophagus area (blunt trauma) and injury to the esophagus during surgery of another organ near the esophagus.
The main symptom is pain when the problem first occurs.
Neck pain or stiffness and air bubbles underneath the skin if the perforation is in the top part of the esophagus.
Air in the soft tissues of the chest.
Fluid that has leaked from the esophagus into the space around the lungs.
Collapsed lung. X-rays taken after you drink a non-harmful dye can help pinpoint the location of the perforation.
You may also have a chest CT scan to look for an abscess in the chest or esophageal cancer.
You may need surgery. Surgery will depend on the location and size of the perforation. If surgery is needed, it is best done within 24 hours.
A stent may be placed in the esophagus if only a small amount of fluid has leaked. This may help avoid surgery.
A perforation in the uppermost (neck region) part of the esophagus may heal by itself if you do not eat or drink for a period of time. In this case, you will need a stomach feeding tube or another way to get nutrients.
Surgery is often needed to repair a perforation in the middle or bottom portions of the esophagus. The leak may be treated by simple repair or by removing the esophagus, depending on the extent of the problem.
The condition can progress to shock, even death, if untreated.
Outlook is good if the problem is found within 24 hours of it occurring. Most people survive when surgery is done within 24 hours. Survival rate goes down if you wait longer.
Tell your provider right away if you develop the problem when you are already in the hospital.
You have recently had surgery or a tube placed in the esophagus and you have chest pain, problems swallowing or breathing.
You have another reason to suspect that you may have esophageal perforation.
These injuries, although uncommon, are hard to prevent.
Maxwell R, Reynolds JK. The management of esophageal perforation. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:73-78.