Esophageal Perforation

Certain injuries or diseases can create a hole in the esophagus. When food is swallowed, some of it can leak out of the esophagus into the chest cavity.

Esophageal perforation often causes:

• burning pain in the chest
• pain with breathing when contents leak out of the esophagus
• fever or other signs of infection

A hole in the esophagus can be caused by certain diseases and conditions, such as:

• gastroesophageal reflux disease, or GERD. This condition, which irritates the lower part of the esophagus, occurs when stomach acids flow back into the esophagus. If GERD isn't treated, it can also create ulcers. These ulcers can eat through the wall of the esophagus, causing a hole.
• traumatic surgery, such as a car crash
• Mallory-Weiss syndrome, a condition in which a person has such severe vomiting that tears occur in the lower part of the esophagus
• cancer of the esophagus

Holes in the esophagus can also be the result of an unintentional injury. Sometimes this occurs when a doctor uses a lighted tube, called an endoscope, to look down a person's esophagus. It also can happen when a healthcare provider inserts a stomach tube through the nose to feed a person or to remove the contents of his or her stomach.

Careful attention can usually prevent injury from endoscope and nasogastric tube insertion. Treatment of gastroesophageal reflux disease can prevent the inflammation and ulcers that cause perforation. Drinking less alcohol can usually prevent the severe vomiting that causes the esophagus to tear. Treatment of esophageal cancer can delay or reduce the risk that the tumor will erode the esophagus.

Perforation can be diagnosed by an upper GI study, a test in which x-rays are taken after the person has swallowed a dye. If the healthcare provider suspects a perforation, endoscopy may be done first. An endoscopy involves the insertion of a thin tube through which the doctor can see the walls of the esophagus.

A perforation can lead to infection or inflammation in the chest. Cancer of the esophagus can spread and lead to death.

There is no risk to others.

Small holes in the esophagus sometimes heal on their own. Usually, however, surgery is needed to close the hole. A person with cancer of the esophagus may get better with radiation therapy or chemotherapy, but may still need surgery to remove the affected tissue.

Any surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

After the esophageal perforation is repaired, the cause of the perforation must be managed. Gastroesophageal reflux disease, for instance, needs careful management to prevent complications.

Once it has been repaired, an esophageal perforation usually needs no monitoring. The diseases that cause it may need to be followed for some time.