Esophageal Rupture and Tears in Emergency Medicine Follow-up

  • Author: Corey M Long, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Apr 28, 2011
 

Further Inpatient Care

  • Patients almost uniformly require intensive care unit admission because they may become septic and can have a complicated hospital course.
  • Patients managed conservatively should take nothing by mouth and be administered parenteral antibiotics for 7-10 days; consideration should be given to intravenous nutrition in the event of a prolonged course. Repeat esophageal studies are utilized to ascertain treatment success.
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Transfer

  • Patients with Boerhaave syndrome must be treated in a center with access to intensive care and cardiothoracic surgery. Transfer may be required to a tertiary care facility if these services are not available at the presenting hospital.
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Complications

  • Complications include pneumonia, mediastinitis, sepsis, empyema, and adult respiratory distress syndrome.
  • Because of improved management, a significant number of patients now survive; recurrent spontaneous ruptures of the esophagus have been described.
  • Esophageal injuries secondary to penetrating trauma often involve adjacent structures such as the spinal cord and trachea.
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Prognosis

  • The prognosis can be poor, especially if diagnosis is delayed. Even with prompt diagnosis and definitive therapy, the hospital course may be prolonged with high rates of morbidity and mortality.
  • The prognosis of cervical iatrogenic perforation is far better than that of spontaneous perforation.
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Contributor Information and Disclosures
Author

Corey M Long, MD  Resident, Department of Emergency Medicine, Bellevue Hospital Center, New York University Medical Center

Corey M Long, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Ugo Anthony Ezenkwele, MD, MPH  Assistant Professor of Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center

Ugo Anthony Ezenkwele, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD  Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Nonenhanced CT scan through the mid esophagus in a patient with esophageal perforation after upper GI endoscopy shows a false tract emanating from the esophagus (arrow).
Nonenhanced CT scan through the mid esophagus in a patient with esophageal perforation after upper GI endoscopy shows leakage of oral contrast material (blue arrow) and air in the posterior mediastinum (red arrow).
Water-soluble contrast esophagram from a patient with esophageal perforation after esophageal dilation shows contrast leak (arrowheads) and normal esophageal lumen (arrows).
 
 
 
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