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Esophagus rupture
Last reviewed: 23.04.2024
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Esophagus rupture can be iatrogenic when performing endoscopic procedures or other manipulations or spontaneous (Burkhava syndrome). The condition of patients is severe, signs of mediastinitis are expressed . The diagnosis is established by esophagography with a water-soluble contrast agent. Need emergency esophagus and drainage.
[What causes esophageal rupture?
Endoscopic procedures are the main cause of rupture of the esophagus, but spontaneous rupture is usually associated with vomiting, vomiting, or ingestion of a large chunk of food. The most common rupture of the esophagus occurs in the distal part of the esophagus on the left side. The acid and contents of the stomach cause fulminant mediastinitis and shock. Pneumomediastinum is characteristic .
Symptoms of rupture of the esophagus
Symptoms of rupture of the esophagus include pain in the sternum, abdominal pain, vomiting, hematomesis and shock. Subcutaneous emphysema is defined in approximately 30% of patients. Mediastinal crepitation (Hammen's sign), creping noises synchronous with cardiac contractions can be detected.
Diagnosis of the esophagus rupture
The air in the mediastinum, the fluid in the pleural cavity, and the widening of the mediastinum, revealed by radiographic examination of the chest and abdominal cavity, presuppose a diagnosis. The diagnosis is confirmed by esophagography with a water-soluble contrast substance, which does not cause significant irritation of the mediastinum, unlike barium. CT of the chest reveals air in the mediastinum and fluid, but does not well localize the perforation. With endoscopy, you can not notice a small perforation.
Treatment of esophagus rupture
In the preoperative period, patients need to introduce broad-spectrum antibiotics (eg, gentamicin and metronidazole or piperacillin / tazobactam) and prescribe infusion intensive therapy, as in shock. Even if the esophagus rupture is treated, there is a high mortality rate.