Esophageal rupture: causes, symptoms, treatment

Perforation, or rather the esophagus rupture - is a violation of the integrity of the esophagus, occurred against the background of trauma or spontaneously. In this state, one help is urgent, since the gap is a real threat to the life of the patient. Eliminate the problem only possible with emergency surgery. In an extreme case, if the patient is in the hospital, and the gaps are small, then perhaps conservative treatment.

Statistics

This type of pathology is very rare, it is approximately 1% of all patients who fall into the thoracic department. Perforation occurs three times more often in male patients. The disease is more common in people aged 50 years and older. Spontaneous rupture of the esophagus, or Burkhawe syndrome, is about 15% of all patients with perforation.

Classification of the disease

Pathology is divided according to the principle of occurrence:

• Independent nosological disease, including the Burkhawe syndrome;
• Complication after another disease, trauma or iatrogenic causes.

In the place of localization:

• Complete rupture of the esophagus, that is, the perforation is localized along the entire thickness of the wall;
• Incomplete perforation, that is, localized on one or several shells of the esophageal mucosa;
• Internal or closed rupture, localization of perforation inside the esophagus;
• External open perforation with a site of localization on the outer walls of the esophagus.

Although for both types of rupture, the symptomatology of the manifestation of the disease is the same.

The Mallory-Weiss Syndrome, or the esophagus crack

A rupture of the esophagus has a similar pathology, like a crack in the stomach or esophagus. Cracks can be single, but can be located throughout the mucosa of the esophagus. For Mallory-Weiss syndrome is not typical damage to connective tissues. Like breaks, cracks are characteristic for patients aged 50 years, male and abusing alcoholic beverages.

Causes

Esophagus rupture often occurs against the background of:

• Frequent endoscopic examinations ;
• Chemical burns;
• Hit foreign bodies, especially acute ones;
• Injuries and penetrating wounds;
• At careless carrying out of various operations, and as a consequence of a trauma of the esophagus.

In rare cases, frequent vomiting or a strong and prolonged cough may lead to ruptures. Generic activities, or more precisely, strong attempts can cause disease. Against the background of an epileptic attack, there may also be a break.

Risk group

This group includes persons with the following pathologies:

• Esophagitis;
• Ulcer of the esophagus with abundant vomiting.

People with the syndrome of uncontrolled overeating are also at risk. The disease can lead to severe physical exertion or overstrain during defecation. At risk are also the male half of humanity from 50 years.

Symptoms of the manifestation of the disease

In most cases, the clinical picture is characterized by a sharp appearance of symptoms and manifests itself in the form:

• Sharp pain in the chest and epigastric region;
• Numbness of limbs;
• Pain in the chest;
• Pallor of the skin throughout the body;
• Dry cough that occurs on the "level ground";
• Increased salivation;
• Tachycardia, dyspnea;
• Indomitable vomiting with impregnations of blood, over time vomiting may seem like coffee grounds;
• Difficulty and heavy breathing;
• Profuse sweating;
• Shock against the background of pain;
• There are signs of an organism intoxication;
• Limbs and face can become blue, and cyanosis develops;
• The rupture in the thoracic region may be characterized by mediastinitis;
• If there is a rupture near the stomach, there may be a peritonitis;
• Emphysema, filled with air, in the face, neck.

The presence of symptoms of esophagus rupture requires immediate medical attention. It is unfortunate, but in 50% of cases of perforation patients die due to untimely recourse for help.

The problem lies also in the plane of the fact that the symptoms of the rupture are also characteristic for a number of other diseases and can be the cause of pleurisy or a heart attack. As a result, without adequate diagnosis and treatment, a person may simply die.

Diagnostic measures

If suspected of esophageal rupture, diagnostic measures are taken in an emergency. To begin with, a physical examination is performed, an anamnesis is revealed. Then the blood is taken for a biochemical and general analysis. X-ray examination and ultrasound are performed. Depending on the localization of pain, an x-ray examination of the chest is performed. Diagnosis also includes mediastinoscopy and pharyngoscopy.

X-ray examination is aimed at identifying fluid and air capsules in the pleura and abdominal cavity. To determine the location of the disease, a water-soluble contrast is introduced into the esophagus, which, migrating, makes it possible to determine the localization and dimensions of the esophagus.

Endoscopy is performed using a rigid endoscope so as not to inflate the esophagus with air.

Healing measures

Treating the esophagus rupture involves surgical intervention.

Very rarely, but still conservative treatment is used. Such measures are possible if the mucosa is damaged by no more than 1.5 cm. This can be a damage to the esophagus with a fish bone or a biopsy needle, the main condition is the absence of damage to the mediastinal organs. In addition, the patient should not have concomitant symptoms, which is an indication for surgical intervention. In this case, active antibiotic therapy is used. Nutrition and drink during treatment does not involve the introduction of food through the mouth. Antibiotics are administered to the patient several times a day and put in complete bed rest. If all measures have not had a positive effect, then you will have to carry out the operation.

However, most often "overcome" the disease and avoid a fatal outcome is possible only with the participation of a surgeon. The main operational activities are aimed at:

• Quicker closing of the gap;
• Drainage of ulcers if they are available to prevent the development of peritonitis;
• Temporary exclusion of the esophagus from the general system of digestion.

After the operation, at least 2 days you should not eat through the mouth. Food is delivered through the gastrostomy. Doctors enter a special nutrient solution.

If the patient's condition allows, the introduction of food by the usual method begins on day 3, but a diet table is laid. The following products are allowed for use:

• Vegetables and fruits in baked form;
• Porridge;
• Soups-mashed potatoes;
• Jelly and compotes;
• Meat and fish, only low-fat breeds, necessarily baked or steamed;
• Puddings of cottage cheese and meat.

You can not eat flour products, including bread. It is forbidden to eat fried and fatty foods, preservation, acidic foods that can irritate the mucous membrane. Products containing dyes.

All products that can be consumed after the operation must have a puree-like consistency or be crushed, before reception it is necessary to bring them to a warm state and use them in small portions.

Possible complications

The consequences of an esophagus rupture can be appalling. The neglected form of the disease can lead to the development of a purulent and inflammatory process, which will lead to damage to the cellulose. Timeliness of treatment is a guarantee of excluding the risk of development of harmful consequences and the onset of death.

Prognosis and prevention

As in the presence of a gap in the esophagus, Mallory-Weiss syndrome, the prognosis for recovery largely depends on the time interval between the onset of treatment and the time of injury to the esophagus. An important role is played by complications that accompany pathology, the location of the localization and the size of the rupture, the general condition of the patient, and chronic diseases.

Preventive measures in this case play a secondary role. Nevertheless, the exclusion of certain factors will prevent the development of the disease. It should avoid iatrogenic damage, do not allow your body to the condition of bulimia, timely pass a medical examination.

Some rules must be followed to minimize the risk of perforation. Teach children to always eat food without hurrying, thoroughly chew it. Often perforation occurs against the background of swallowing a large chunk of food. Do not forget the saying "when I eat, I'm deaf and dumb." You should give up strong physical exertion, from lifting weights. Meals should be balanced and correct, do not abuse alcoholic beverages.