gastrointestinal disorders
Esophageal Rupture
Introduction
Esophageal rupture may be iatrogenic during endoscopic procedures or other instrumentation or may be spontaneous (Boerhaave syndrome). Patients are seriously ill, with symptoms of Mediastinitis . Diagnosis is by esophagography with a water-soluble contrast agent. Immediate surgical repair and drainage are required. (See also Overview of Esophageal and Swallowing Disorders .) Endoscopic procedures are the primary cause of esophageal rupture, but spontaneous rupture may occur, typically related to vomiting, retching, or swallowing a large food bolus. Spontaneous rupture is especially likely in patients who have untreated Eosinophilic Esophagitis . The most common site of rupture is the distal esophagus on the left side. Acid and other stomach contents cause a fulminant mediastinitis and shock. Pneumomediastinum is common. 