Esophageal perforation - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T22:53:03Z

Prepared the page for translation

Rossdonaldson1: /* Background */

2024-02-07T22:27:08Z

Background

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	[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]		[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
	[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]		[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
			[[File:Illu esophagus.jpg\|thumb\|Esophagus anatomy and nomenclature based on two systems.]]
	*Also known as "Boerhaave syndrome"		*Also known as "Boerhaave syndrome"
	*Full thickness perforation of the esophagus		*Full thickness perforation of the esophagus

Rossdonaldson1: /* Background */

2023-11-01T22:01:00Z

Background

← Older revision		Revision as of 22:01, 1 November 2023
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	[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]		[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
	[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]		[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
			*Also known as "Boerhaave syndrome"
	*Full thickness perforation of the esophagus		*Full thickness perforation of the esophagus
	*Secondary to sudden increase in esophageal pressure		*Secondary to sudden increase in esophageal pressure
	*Perforation is usually posterolateral		*Perforation is usually posterolateral
	*Also known as "Boerhaave syndrome''

	===Causes===		===Causes===

Rossdonaldson1 at 20:15, 1 November 2023

2023-11-01T20:15:33Z

← Older revision		Revision as of 20:15, 1 November 2023
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	*Secondary to sudden increase in esophageal pressure		*Secondary to sudden increase in esophageal pressure
	*Perforation is usually posterolateral		*Perforation is usually posterolateral
			*Also known as "Boerhaave syndrome''

	===Causes===		===Causes===
	*Iatrogenic (most common)		*Iatrogenic (most common)
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	==Clinical Features==		==Clinical Features==
	===Mackler's Triad===		===Mackler's Triad===
	''Pathognomonic for [[Boerhaave syndrome]]''		''Pathognomonic for Boerhaave syndrome''
	#[[Chest pain]]		#[[Chest pain]]
	#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>

Rossdonaldson1: /* Mackler's Triad */

2023-11-01T20:10:38Z

Mackler's Triad

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	#*In about 25% of the patientsMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*In about 25% of the patientsMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
	#[[Subcutaneous emphysema]]		#[[Subcutaneous emphysema]]
	***Palpable in up to 60% of patients<ref>Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res. 2010;3(6):235-244. doi:10.4021/gr263w</ref>		#*Palpable in up to 60% of patients<ref>Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res. 2010;3(6):235-244. doi:10.4021/gr263w</ref>

	===Other Possible Symptoms===		===Other Possible Symptoms===

Rossdonaldson1: /* Mackler's Triad */

2023-11-01T20:10:22Z

Mackler's Triad

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	#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
	#*Usually acute and sudden in onset		#*Usually acute and sudden in onset
	**May be worse on neck flexion or with swallowing		#*May be worse on neck flexion or with swallowing
	#*Radiation to the back or to the left shoulder		#*Radiation to the back or to the left shoulder
	#[[Vomiting]] (+/- [[shortness of breath]])		#[[Vomiting]] (+/- [[shortness of breath]])

Rossdonaldson1: /* Clinical Features */

2023-11-01T20:10:03Z

Clinical Features

← Older revision		Revision as of 20:10, 1 November 2023
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	#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
	#*Usually acute and sudden in onset		#*Usually acute and sudden in onset
			**May be worse on neck flexion or with swallowing
	#*Radiation to the back or to the left shoulder		#*Radiation to the back or to the left shoulder
	#[[Vomiting]] (+/- [[shortness of breath]])		#[[Vomiting]] (+/- [[shortness of breath]])
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	*[[Neck pain]]		*[[Neck pain]]
	**When cervical esophagus is perforated		**When cervical esophagus is perforated
	*Dysphonia, hoarseness, ~~cervical~~ dysphagia		*Dysphonia, hoarseness, [[dysphagia]]
	*Acute abdominal or [[epigastric pain]]		*Acute abdominal or [[epigastric pain]]
	**Rarely manifest with hematemesis or other signs of gastrointestinal bleeding, including melenaMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		**Rarely manifest with hematemesis or other signs of gastrointestinal bleeding, including melenaMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
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	*[[Sepsis]]		*[[Sepsis]]
	*Overwhelming bacterial [[mediastinitis]]		*Overwhelming bacterial [[mediastinitis]]
			**Hamman's sign
	*Multiple organ failure		*Multiple organ failure
	*[[Death]]		*[[Death]]


	~~===History===~~
	*[[chest pain\|Pain]]
	**Acute, severe, unrelenting, diffuse
	**May be worse on neck flexion or with swallowing
	**May be localized to chest, neck, abdomen; radiate to back and shoulders
	**Occurs suddenly, often after forceful vomiting
	*[[Dysphagia]]
	*[[Dyspnea]]
	*[[Hematemesis]]

	~~===Physical Exam===~~
	*Cervical subcutaneous emphysema
	*Mediastinal emphysema
	**Takes time to develop
	**Absence does not rule out perforation
	**Hamman's sign
	***Mediastinal crunching sound
	*May rapidly develop [[sepsis]] due to [[mediastinitis]]

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1 at 20:07, 1 November 2023

2023-11-01T20:07:01Z

← Older revision		Revision as of 20:07, 1 November 2023
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	==Clinical Features==		==Clinical Features==
	===Mackler ~~triad~~===		===Mackler's Triad===
			''Pathognomonic for [[Boerhaave syndrome]]''
	#[[Chest pain]]		#[[Chest pain]]
	#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*Present in more than 70% of patients with a full thickness perforation of the intrathoracic esophagusMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
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	#*In about 25% of the patientsMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>		#*In about 25% of the patientsMackler triad<ref>Søreidecorresponding JA, et al. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011; 19:66. doi: 10.1186/1757-7241-19-66, </ref>
	#[[Subcutaneous emphysema]]		#[[Subcutaneous emphysema]]
			***Palpable in up to 60% of patients<ref>Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res. 2010;3(6):235-244. doi:10.4021/gr263w</ref>

	===Other Possible Symptoms===		===Other Possible Symptoms===
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	*[[Death]]		*[[Death]]

	~~==Mackler’s triad==~~
	*Pathognomonic for [[Boerhaave syndrome]]
	**[[Chest pain]]
	**[[Vomiting]]
	**Subcutaneous emphysema
	***Palpable in up to 60% of patients<ref>Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res. 2010;3(6):235-244. doi:10.4021/gr263w</ref>

	===History===		===History===

Rossdonaldson1: /* Background */

2023-11-01T20:05:15Z

Background

← Older revision		Revision as of 20:05, 1 November 2023
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	==Background==		==Background==
			[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
	[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]		[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
	*Full thickness perforation of the esophagus		*Full thickness perforation of the esophagus

Rossdonaldson1: /* Background */

2023-11-01T20:03:41Z

Background

← Older revision		Revision as of 20:03, 1 November 2023
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	==Background==		==Background==
			[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
	*Full thickness perforation of the esophagus		*Full thickness perforation of the esophagus
	*Secondary to sudden increase in esophageal pressure		*Secondary to sudden increase in esophageal pressure