Rupture of the esophagus
The rupture of the esophagus is called a rupture in medical terminology. This is one Tear of the esophagus (Esophagus) so that a Passage into the rib cage arises.
A rupture can occur in the frame various diseases or events arise. So tear for example also with that Boerhaave syndrome all wall layers of the esophagus. In many cases the mucous membrane of the esophagus is already damaged by various causes, which also promotes an injury.
The tear represents a life threatening situation for the patient, because heavy bleeding can occur, which is often difficult to control due to the location. In addition, there is the risk that the entire chest is contaminated and thus an inflammation develops, which as Mediastintis referred to as. Hence a quick treatment a tear in the esophagus with intensive care monitoring required.
Symptoms of a ruptured esophagus
If the esophagus ruptures, there is serious organ damage in the body, which usually leads to very severe pain behind the breastbone. These usually set in very suddenly and are often described as burning or tearing. The pain often also radiates to the back. Radiation into the abdomen or one of the two arms is also possible. Some people also vomit, which is usually bloody. These complaints are usually accompanied by a pronounced feeling of fear. In addition, there may be shortness of breath and circulatory failure, which leads to loss of consciousness.
The most important thing in such a case is that an emergency doctor is called immediately! The symptoms described can all also occur in the event of a heart attack, so that the doctor must use the appropriate procedure to find the correct diagnosis and initiate therapy. However, there is another sign that suggests that the esophagus ruptured. As a result of the tear, it is possible for air to enter the body cavities, which may penetrate under the skin from the inside and make itself felt through a crackling sound above the chest. However, this so-called skin emphysema is often not found.
A tear in the esophagus is associated with some discomfort and symptoms. Particularly typical is a sudden onset of very strong pain behind the breastbone (sternum). The pain is often tearing and burning, especially if the lining of the esophagus is already inflamed. The pain may radiate to the abdomen, back or arm.
Depending on the cause of the esophagus tearing, the severe pain behind the breastbone can also be accompanied by vomiting. For many patients, the pain can be unbearable and often frightens them, so that breathing becomes difficult in the further course. Then there is the risk that the patient will also get circulatory failure (shock) and lose consciousness.
Read more on the topic: Esophagus pain.
If the patient has no previous illnesses that would explain the pain, a good differential diagnosis must be carried out.
For example, the tear in the esophagus can be confused with pain caused by an acute heart attack. The pain is also known as annihilation pain and is usually treated with strong pain relievers.
Read more on the topic: Sternum pain.
Causes of a ruptured esophagus
A rupture of the esophagus can occur for a number of reasons. It often affects patients who suffer from a disease that damages the lining of the esophagus. This makes it more prone to injury. The possible causes are therefore: excessive alcohol consumption, patients with an eating disorder, frequent vomiting and reflux disease.
In reflux disease, stomach contents flow back into the esophagus after eating and when lying down and extremely irritate the mucous membrane, which can lead to extensive inflammation. The reason for the backflow of gastric acid is usually a restricted function of the sphincter between the esophagus and stomach.
Excessive pressure in the abdomen can also tear the esophagus. This occurs, for example, with severe vomiting or extreme coughing fits.
Furthermore, injuries from foreign bodies or from outside can also be responsible for tearing the esophagus. This can involve stab wounds or the swallowing of a sharp object, which then tears the mucous membrane of the esophagus.
Some medical procedures can also seriously injure the esophagus.
An endoscopy is done to examine the stomach or intestines. If the esophagus is thin or the doctor has handled it poorly, the endoscope can seriously damage the wall of the esophagus, especially if it is already in poor condition.
An esophageal tear can also from very strong and frequent vomiting arise. Vomiting is also the cause of a tear in the esophagus Boerhaave syndrome.
Vomiting can be triggered by a variety of causes. In most cases it occurs rich food or excessive alcohol consumption on. Furthermore, there are also patients with a eating disorder in form of a bulimia affected by it. These patients will vomit after eating so as not to gain weight.
When vomiting becomes a very strong and high pressure built up in the abdomen. When the patient finally vomits, this intra-abdominal pressure is released and the tissue can tear. Especially previously damaged mucous membraneAs is the case with bulimia or alcoholics, injury can quickly be damaged because the wall layers are no longer stable enough.
There is now one through the crack Connection between the esophagus and the chest area. This can now stomach contents flow into the chest and a cause severe inflammation. This inflammation is called Mediastinitis referred to and may as a result a Blood poisoning (Sepsis).
Patients must immediately intensive care and operational treated be as they otherwise often die from this complication. The defect in the esophagus is closed with a surgical procedure and the causes of the vomiting should then be clarified.
Regular to excessive consumption of alcohol can in some cases also cause one chronic alcohol abuse to lead. This has serious effects on the entire body.
That's how it is most common consequence the Destruction of the liverwhat among medical professionals as Cirrhosis of the liver referred to as. This eventually leads to the alcoholic's liver no longer working properly. There is also one in patients with excessive alcohol consumption increased risk of cancer and other tissue disorders. The mouth, throat and esophagus are particularly badly affected.
The constant alcohol that is toxic to the body leads to a Irritation of the mucous membrane. The mucous membrane is called the squamous epithelium and can change significantly as a result, which causes the Favors the development of cancer becomes. They also occur very frequently Esophagitis on, whereby the mucous membrane and also the underlying wall layers, such as the muscles, are severely damaged. This previous damage will also cause a Tear in the esophagus promoted. It arise heavy bleeding and the risk of getting one Inflammation forms in the chest. The tear in the esophagus represents a life threatening situation and often the affected patients die from the complications mentioned.
Treatment of a tear in the esophagus
A rupture of the esophagus is a medical emergency and a life-threatening situation that should be treated as soon as possible. The patient has to be taken to a hospital with circulatory monitoring and operated directly. In addition, antibiotics with a broad spectrum of action are administered to prevent infection of the body cavity in which the esophagus is located. The surgery may not be able to close the tear in the esophagus.
The last thing to do to save the patient's life is to remove the affected section of the esophagus. After that, the stomach must be pulled up and sutured to the remaining end to restore a closed digestive tract.
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