Esophageal perforation
| Classification according to ICD-10 | |
|---|---|
| K22.3 | Perforation of the esophagus |
| S27.8 | Injury to other specified intrathoracic organs - esophagus (pars thoracica) |
| ICD-10 online (WHO version 2019) | |
The perforation of the esophagus ( Latin: esophagus ) is called esophageal perforation . Such a perforation usually requires immediate surgical closure. The mortality rate is around 10–30%. Overall, the disease rarely occurs.
causes
There are many different causes of esophageal perforation. Most often, the rupture of the esophagus is caused by medical measures ( iatrogenic ), usually reflections . Other causes are swallowed foreign bodies , severe reflux disease or spontaneous rupture (tearing), which is also known as Boerhaave's syndrome .
Clinical picture and diagnostics
The symptoms of esophageal perforation are varied. They include pain, vomiting of blood ( hematemesis ), circulatory reactions ( tachycardia , hypotension up to shock ) and, under certain circumstances, skin emphysema (free air under the skin), which occurs especially when the neck area ruptures. The symptoms are very variable and depend on the location and extent of the rupture.
The majority of the cases by a radiograph of the thorax are detected. Air in the mediastinum (middle layer) with widening of the same, skin emphysema and fluid level in the mediastinum or a sero / pneumothorax in the case of ruptures in the lower third of the esophagus are indications of a perforation. An exudate-related pleural effusion can also result from an esophageal perforation. Further procedures are contrast media recordings or a representation in computed tomography . Endoscopic examinations can be helpful, but may miss the perforation site.
therapy
Surgical closure of the opening is usually necessary. In addition, a balanced fluid balance is striven for by giving infusions and prophylactic antibiotics are administered. In the event of a rupture due to previous diseases of the esophagus (severe inflammation, megaesophagus , carcinoma , chemical burns ), a resection of the affected section is performed. A conservative approach (without surgery) is possible in individual cases for small, uncomplicated tears. After the rupture has been closed, long-term monitoring for strictures , reflux diseases, and carcinomas is necessary.
source
- JB Zwischenberger, C. Savage, A. Bidani: Surgical aspects of esophageal disease: perforation and caustic injury. In: Am J Respir Crit Care Med. 2002 Apr 15; 165 (8), pp. 1037-1040. Review. PMID 11956041
Individual evidence
- ↑ Berthold Jany, Tobias Welte: Pleural effusion in adults - causes, diagnosis and therapy. In: Deutsches Ärzteblatt. Volume 116, No. 21, (May) 2019, pp. 377-385, here: p. 379.
