Perforation of the oesophagus resulting in leakage of the contents.
A rare complication of endoscopy, foreign bodies and trauma. Occasionally a rupture following forceful vomiting may occur (Boerhaave’s syndrome).
Perforation usually occurs at the pharyngeooesophageal junction. It results in release of secretions into the mediastinum.
Presentations include surgical emphysema of the neck; intense retrosternal pain, tachycardia and fever in mediastinitis; subdiaphragmatic perforation causes peritonitis.
CXR may reveal air in the mediastinum or soft tissues (surgical emphysema).
Small perforations occurring in the neck are managed with broad-spectrum antibiotics and nasogastric tube. Large thoracic perforations are repaired with a gastric fundus patch. Oesophageal perforation secondary to malignancy at or above the lower oesophageal sphincter can be treated with a covered metal stent placed endoscopically.