A ruptured esophagus, also known as esophageal perforation or Boerhaave syndrome, is a serious medical emergency where a tear occurs in the wall of the tube connecting the mouth to the stomach. This allows contents from the esophagus, such as food, fluids, and digestive chemicals, to leak into the chest cavity. This leakage can lead to inflammation and infection in surrounding tissues and organs, making prompt recognition of signs important due to its severe nature.
The Immediate Sensations
The onset of a ruptured esophagus involves sudden, severe chest pain that is sharp, tearing, or excruciating. This intense pain often localizes in the lower chest, behind the breastbone, but can extend to the upper abdomen. The sensation may radiate to the back, neck, or left shoulder, potentially confused with other serious conditions like a heart attack. The pain’s abrupt appearance is a distinct characteristic, often occurring immediately after an event that significantly increases pressure within the esophagus. Swallowing can intensify this chest pain, and discomfort may be felt in the neck or upper chest if the rupture is higher.
Developing Signs and Systemic Responses
Beyond the immediate, severe pain, additional symptoms emerge as the body reacts to esophageal contents leaking into the chest. Many individuals experience severe vomiting, which might sometimes include blood. Difficulty swallowing (dysphagia) or pain when swallowing (odynophagia) can also develop. As the condition progresses, signs of systemic response become apparent, including rapid and shallow breathing and shortness of breath.
A rapid heart rate and a drop in blood pressure are common as the body attempts to compensate for spreading inflammation and potential infection. Fever and chills may also indicate infection within the chest cavity. Subcutaneous emphysema, where air from the rupture collects under the skin, creates a crackling sensation when touched, particularly in the neck or chest. These signs collectively point to a worsening condition requiring urgent evaluation.
Underlying Causes
A ruptured esophagus can stem from factors that either increase pressure within the esophagus or cause direct trauma to its wall. One of the most common causes, particularly for spontaneous ruptures known as Boerhaave syndrome, is severe and forceful vomiting or retching. This intense straining can lead to a sudden increase in pressure inside the esophagus, causing it to tear.
Medical procedures involving the esophagus, such as endoscopy, stent placement, or dilation, are also frequent causes of perforation. These are termed iatrogenic injuries and account for a significant portion of all esophageal ruptures. Physical trauma to the chest or neck, including blunt force injuries or penetrating injuries, can directly damage the esophageal wall. Additionally, accidental ingestion of sharp foreign objects or corrosive substances can erode or puncture the esophagus, leading to a rupture.
When to Seek Emergency Care
A ruptured esophagus is a life-threatening medical emergency that demands immediate attention. If you experience sudden, severe chest pain, especially following forceful vomiting or a traumatic event, it is crucial to seek emergency medical care. This condition requires urgent diagnosis and prompt intervention to prevent serious complications such as widespread infection and organ failure. Early medical evaluation significantly improves outcomes.