An esophageal perforation is a hole in the esophagus. The esophagus is the tube food passes through as it goes from the mouth to the stomach.
The contents of the esophagus can pass into the surrounding area in the chest (mediastinum), when there is a hole in the esophagus. This often results in infection of the mediastinum (mediastinitis).
The most common cause of an esophageal perforation is injury during a medical procedure. However, the use of flexible instruments has made this problem rare.
The esophagus may also become perforated as the result of:
Less common causes include injuries to the esophagus area (blunt trauma) and injury to the esophagus during surgery of another organ near the esophagus.
The main symptom is pain when the problem first occurs.
A perforation in the middle or lower most part of the esophagus may cause:
Your health care provider will look for:
You may have a chest x-ray to look for:
You may also have a chest CT scan to look for an abscess in the chest or esophageal cancer.
You may need surgery. Surgery will depend on the location and size of the perforation. If surgery is needed, it is best done within 24 hours.
Treatment may include:
A stent may be placed in the esophagus if only a small amount of fluid has leaked. This may help avoid surgery.
A perforation in the uppermost (neck region) part of the esophagus may heal by itself if you do not eat or drink for a period of time. In this case, you will need a stomach feeding tube or another way to get nutrients.
Surgery is often needed to repair a perforation in the middle or bottom portions of the esophagus. The leak may be treated by simple repair or by removing the esophagus, depending on the extent of the problem.
The condition can progress to shock, even death, if untreated.
Outlook is good if the problem is found within 24 hours of it occurring. Most people survive when surgery is done within 24 hours. Survival rate goes down if you wait longer.
Complications may include:
Tell your provider right away if you develop the problem when you are already in the hospital.
Go to the emergency room or call 911 if:
These injuries, although uncommon, are hard to prevent.
Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.