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.
Perforation of the esophagus
The contents of the esophagus can pass into the area 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.
The esophagus may also become perforated as the result of:
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.
Treatment may include:
Fluids given through a vein (IV)
IV antibiotics to prevent or treat infection
Draining of fluid around the lungs with a chest tube
Mediastinoscopy to remove fluid that has collected in the area behind the breastbone and between the lungs (mediastinum)
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.
Complications may include:
Permanent damage to the esophagus (narrowing or stricture)
Abscess formation in and around the esophagus
Infection in and around the lungs
When to Contact a Medical Professional
Tell your health care provider right away if you develop the problem when you are already in the hospital.
Go to the emergency room or call 911 if:
You have recently had surgery or a tube placed in the esophagus and you have pain, problems swallowing or breathing
You have another reason to suspect that you may have esophageal perforation.
Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.