Esophageal Rupture Clinical Presentation

Updated: Feb 24, 2017
  • Author: Dale K Mueller, MD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Presentation

History

The classic presentation of spontaneous esophageal rupture is that of a middle-aged man with a history of dietary overindulgence and overconsumption of alcohol who experiences chest pain and subcutaneous emphysema after recent vomiting or retching (Mackler triad). The classic Mackler triad is present in approximately 50% of cases.

Typical symptoms include the following:

  • Pain of variable location, commonly in the lower anterior chest or upper abdomen
  • Vomiting
  • Subcutaneous emphysema
  • Neck pain
  • Dysphagia
  • Dyspnea
  • Hematemesis
  • Melena
  • Back pain

Atypical symptoms include the following:

  • Shoulder pain
  • Facial swelling
  • Hoarseness
  • Dysphonia

Because spontaneous esophageal rupture is a life-threatening emergency, clinicians should be aware of its atypical presentations. [9]

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Physical Examination

Physical signs include the following:

  • Fever
  • Crepitus
  • Tachycardia
  • Tachypnea
  • Cyanosis
  • Dyspnea
  • Upper abdominal rigidity
  • Shock
  • Local tenderness

The combination of subcutaneous emphysema, rapid respirations, and abdominal rigidity is commonly referred to as the Anderson triad.

An underrecognized possible presenting feature of spontaneous esophageal rupture is pneumothorax, which may be present in as many as 20% of such cases. [12]

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Complications

Complications of esophageal rupture include the following:

  • Mediastinitis
  • Intrathoracic abscess
  • Sepsis
  • Respiratory failure
  • Shock
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