Definition Oesophageal perforation is a hole in the wall of the oesophagus, which is the muscular tube that carries food from the mouth to the stomach.
What is going on in the body? Certain injuries or diseases can create a hole in the oesophagus. When food is swallowed, some of it can leak out of the oesophagus into the chest cavity.
What are the signs and symptoms of the condition? Oesophageal perforation often causes:
pain with breathing when contents leak out of the oesophagus
What are the causes and risks of the condition? A hole in the oesophagus can be caused by certain diseases and conditions, such as:
gastro-oesophageal reflux disease, or GORD. This condition, which irritates the lower part of the oesophagus, occurs when stomach acids flow back into the oesophagus. If GORD isn't treated, it can also create ulcers. These ulcers can eat through the wall of the oesophagus, causing a hole.
Mallory-Weiss syndrome, a condition in which a person has such severe vomiting that tears occur in the lower part of the oesophagus
Holes in the oesophagus can also be the result of an accidental injury. Sometimes this occurs when a doctor uses a lighted tube, called an endoscope, to look down a person's oesophagus. It also can happen when a doctor inserts a stomach tube through the nose to feed a person or to remove the contents of his or her stomach.
What can be done to prevent the condition? Careful attention can usually prevent injury from endoscope and nasogastric tube insertion. Treatment of gastro-oesophageal reflux disease can prevent the inflammation and ulcers that cause perforation. Drinking less alcohol can usually prevent the severe vomiting that leads to tears. Treatment of cancer of the oesophagus can delay or lower the risk of holes.
How is the condition diagnosed? Perforation can be diagnosed by an upper GI study, a test in which x-rays are taken after the person has swallowed a thick dye. If the doctor suspects a perforation, endoscopy may be done first. An endoscopy involves the insertion of a thin tube through which the doctor can see the walls of the oesophagus.
What are the long-term effects of the condition? A perforation can lead to infection or inflammation in the chest area. Cancer of the oesophagus can spread and lead to death.
What are the risks to others? There is no risk to others.
What are the treatments for the condition? Small holes in the oesophagus sometimes heal on their own. Usually, though, surgery is needed to close the hole. A person with cancer of the oesophagus may get better with radiation therapy or chemotherapy, but may still need surgery to remove the affected area.
What are the side effects of the treatments? Any surgery can cause bleeding, infection, or allergic reaction to the anaesthesia.
What happens after treatment for the condition? After the oesophageal perforation is repaired, the cause of the perforation must be managed. gastro-oesophageal reflux disease, for instance, needs careful management to prevent complications.
How is the condition monitored? Once it has been repaired, an oesophageal perforation usually needs no monitoring. The diseases that cause it may need to be followed for some time.
Author: William M. Boggs, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
