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Esophageal Perforation: Pearls and Pitfalls for the Resuscitation Room

Esophageal perforation is a rare but frequently life-threatening condition that requires consideration in the appropriate clinical context in order to diagnose upon initial presentation. While the etiologies of this pathology are vast, by far most common is an iatrogenic cause, often secondary to endoscopic procedures. However, iatrogenic esophageal perforation is frequently recognized during the procedure, and so may not be the most common etiology presenting to the ED. The lack of serosal layer makes the esophagus more prone to rupture, compared with the rest of the GI tract. Additional etiologies of esophageal perforation include trauma, foreign body or caustic ingestion, invasive neoplasm

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Articles of Interest

Blunt Trauma Patient with Esophageal Perforation

Traumatic perforation of the esophagus due to blunt trauma is a rare thoracic emergency. The most common causes of esophageal perforation are iatrogenic, and the upper cervical esophageal region is the most often injured. Diagnosis is frequently determined late, and mortality is therefore high.

Advances in Treating Esophageal Perforation

Decisions regarding the treatment of patients with an esophageal perforation or spontaneous rupture are usually tackled in the emergency care setting. In recent years, the viable treatment options for patients with such life-threatening problems have expanded with development of new techniques and more widespread use of collaborative care.

Management of traumatic esophageal injuries

Traumatic esophageal perforations are rare but difficult to treat injuries.

Treatment of Esophageal Injury

The relative infrequency of esophageal injury may be attributed to the deep location of this collapsed structure that is surrounded by vital organs. Many penetrating wounds injure the heart or aorta and result in death at the scene. Blunt injuries to the esophagus are very unusual. Anatomic features, with the lack of serosa, contribute to the difficulty in treatment. Given the frequency of delay in diagnosis and the complexity of operative treatment, injuries of the esophagus remain among the most difficult injuries to manage without major morbidity or mortality. Even the busiest trauma centers often encounter fewer than five esophageal injuries per year.