Esophageal Perforation

Esophageal perforation is a hole in the esophagus – the muscular tube our food travels through on its way from the mouth to the stomach – that allows saliva, liquids, and food to spill into the thoracic cavity or abdomen. It’s an uncommon but serious medical condition.

Perforation of the esophagus is usually caused by prolonged vomiting and forceful retching, the ingestion of bones, or after surgery or instrumentation of the esophagus (endoscopy and biopsies). The perforation can occur at any point along the esophagus, including the neck, chest, and abdomen.

The specialized group of thoracic surgeons at UT Southwestern Medical Center treat esophageal perforation using a number of cutting-edge techniques, and they work closely with other physician groups throughout UT Southwestern to provide expert multidisciplinary care.

Symptoms

Manifestations of esophageal perforation include:

• Air bubbles under the skin
• Difficulty swallowing
• Fever and chills
• Low blood pressure and rapid heart rate
• Pain at the perforation site (in the neck, chest, or abdomen)
• Rapid or labored breathing
• Vomiting

Diagnosis

If we suspect that you have esophageal perforation, we will conduct a physical examination and order imaging studies to confirm the diagnosis. These studies might include:

• Chest X-rays
• Computed tomography (CT) scans
• Barium swallow study
• Endoscopy to inspect the site and degree of perforation

Treatment

Not all esophageal perforations require treatment – it depends upon a perforation’s size and location – but in some cases, an esophageal perforation can be a life-threatening condition that requires prompt surgical repair in addition to intravenous fluids and antibiotics.

Based on the severity of the perforation and the clinical findings, a number of procedures can be performed, including:

• Drainage of the spilled fluid and food with chest tubes
• Endoscopy and stent placement (a hollow tube is placed in the esophagus to occlude the hole)
• Esophagectomy in extreme cases when the esophagus cannot be repaired
• Minimally invasive repair of the perforation site
• Open repair of the perforation

Clinical Trials

In addition to standard treatments for esophageal perforation, UT Southwestern gives patients access to the most promising new therapies through clinical trials. Talk with your doctor to see if a clinical trial may be right for you.