Fact-sheet: Esophageal perforation
Updated on 06/29/2020 at 11:01 AM
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Definition
Spontaneous perforations, that is, occurring outside the setting of trauma (most often iatrogenic or endoscopic), of the esophagus are known as Boerhaave syndrome.
Like Mallory-Weiss syndrome, Boerhaave syndrome results from an increase in intraesophageal pressure, often related to vomiting (classically in alcoholic patients), which can cause the esophagus to dilate up to 5 times its normal diameter.
Perforation is generally the result of a weak point in the esophageal wall located in the lower third of the esophagus along the left border, and results in mediastinitis.
Clinical features
Pain localized to the base of the thorax or epigastrium, vomiting, cervical subcutaneous emphysema, respiratory distress.
Onset of pain in a context of forceful vomiting is also suggestive.
CT
Indirect signs: posterior mediastinal fluid collection indicating mediastinitis, posterior pneumomediastinum that may extend into the retroperitoneum, digestive wall signs in the form of localized thickening of the esophageal wall.
Exceptionally, it identifies a wall discontinuity, a direct sign of perforation.