eMedicine Specialties > Emergency Medicine > Gastrointestinal

Esophageal Perforation, Rupture and Tears: Follow-up

Author: Corey M Long, MD, Resident, Department of Emergency Medicine, Bellevue Hospital Center, New York University Medical Center
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
Contributor Information and Disclosures

Updated: Mar 23, 2009

Follow-up

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.

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.

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • With a high index of suspicion, a negative water-soluble contrast study is not sufficient to rule out the diagnosis of esophageal tear.
  • While evidence has begun to accumulate regarding specific treatment approaches, this remains a rare condition and, as such, many suggestions are based on case series or personal experience.

Special Concerns

  • Early diagnosis is crucial in Boerhaave syndrome. It is important to consider the possibility in any patient presenting with atypical chest or abdominal pain.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Martin J Carey, MD, to the development and writing of this article.



More on Esophageal Perforation, Rupture and Tears

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Differential Diagnoses & Workup: Esophageal Perforation, Rupture and Tears
Treatment & Medication: Esophageal Perforation, Rupture and Tears
Follow-up: Esophageal Perforation, Rupture and Tears
Multimedia: Esophageal Perforation, Rupture and Tears
References
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Further Reading

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Keywords

esophageal perforation, esophageal rupture, esophageal tear, esophagus tear, Boerhaave's syndrome, Boerhaave syndrome, iatrogenic perforation, esophagus, Mackler's triad, Hamman sign, blunt trauma, treatment, causes, symptoms, penetrating trauma to the neck, Mallory-Weiss tear, gastroesophageal reflux disease, spontaneous esophageal rupture 

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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.

Medical Editor

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, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eugene Hardin, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles R Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King, Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

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, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier 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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