An esophageal rupture is a medical emergency. When the wall of your esophagus is perforated or torn, food, chemicals and bacteria from your gastrointestinal tract can escape into your chest. This can cause inflammation, infection and life-threatening complications.
Your esophagus is the swallowing tube that connects your mouth to your stomach. A rupture in your esophagus means a hole, perforation or tear through the esophagus wall. This is very serious.
Your esophagus passes through your chest cavity (thorax), right between your lungs. As part of your gastrointestinal tract, it carries the solids and liquids you ingest as well as bacteria and body chemicals belonging to your digestive system.
These contents are harmful when they escape your GI tract and leak into other places in your body. If they leak from your esophagus, they can cause an infection in your chest, lungs or bloodstream.
These infections can be life-threatening, so finding and managing them quickly is paramount. An esophageal rupture should be treated within 24 hours for the best outcome. This may mean endoscopic or surgical treatment.
Esophageal ruptures are rare. In the United States, they occur in .003% of the population.
A Mallory-Weiss tear is a split or tear in the inner lining of your esophagus. It doesn’t go all the way through the wall of your esophagus.
An esophageal variceal rupture is a rupture of swollen veins in your esophagus. It might bleed a lot, but it isn’t a rupture of your esophagus itself.
A rupture is usually caused by an injury to your esophagus. Your esophagus can be injured from the outside or the inside. Some injuries occur suddenly during a traumatic event, and some progress slowly.
More rarely, your esophagus can rupture spontaneously under tremendous stress. This is also called an effort rupture, or Boerhaave’s syndrome. It usually happens during forceful and repeated vomiting.
Most injuries that cause esophageal ruptures occur during medical procedures, especially endoscopic procedures that treat your esophagus through the endoscope. These are called iatrogenic ruptures.
Other causes of esophageal ruptures include:
Your esophagus doesn’t have an outer lining (serosal layer) like most of your organs do. This makes it more vulnerable to rupture in general. It’s especially vulnerable if the inner lining is inflamed or injured.
This might be the case if you have a history of:
Common symptoms of an esophageal rupture include:
Most ruptures occur in the middle to lower section of the esophagus, which is in your chest. If your rupture is higher or lower in your esophagus, you might feel pain in your neck, abdomen or right shoulder blade.
When gastrointestinal contents leak through the hole in your esophagus, they can cause:
If you suspect you have a rupture, go to the E.R. right away. Severe pain and difficulties swallowing or breathing are emergency symptoms. Tell a healthcare provider what was happening when they started.
If your symptoms started immediately after an injury, swallowing something you shouldn’t have or an episode of violent vomiting, an esophageal rupture is possible. Your provider will look for the evidence.
A healthcare provider will order imaging of your esophagus to look for a rupture. They will usually begin with a chest X-ray. They’ll look for evidence of leaked fluids or air pockets in your chest tissues.
To confirm their findings, they may order a more sensitive type of X-ray called an esophagram. For this test, you swallow a contrast dye solution that will highlight the inside of your esophagus on the X-ray.
A contrast-dye esophagram can help providers locate the rupture in your esophagus if they’re having trouble finding it. They’ll be able to see the dye leaking through the perforation, and how fast it leaks.
They may also suggest a CT scan, especially if they suspect a rupture in the upper or lower portion of your esophagus. A CT scan can find pockets of leaked fluids in your neck or abdomen that may need draining.
Standard treatment includes:
Yes, but your prognosis depends on how soon you receive treatment. The more time infections have to spread from the rupture through your chest cavity and bloodstream, the more at risk you are.
Those who receive treatment within the first 24 hours of rupture are likely to make a full recovery. The survival rate in this group is 85%. After 48 hours without treatment, the survival rate falls to 50%.
A note from Cleveland Clinic
Esophageal ruptures are frightening anomalies. Fortunately, they’re rare. But when they do occur, they can be difficult to recognize right away. This is one of many reasons to always take chest pain seriously.
Your esophagus wall is thin and vulnerable, and it can be injured unexpectedly. When it’s injured, you might not realize where the pain is coming from or what it means. Regardless, don’t try to tough it out.
If you ever feel a sudden severe pain in your chest, or even your throat or upper abdomen, go to the emergency room. Even a small rupture can lead to infection and all of its possible complications.
Last reviewed by a Cleveland Clinic medical professional on 10/11/2022.
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