Ear, Nose & Throat ENT Disorders The Causes, Signs, and Symptoms of a Perforated Esophagus By Kristin Hayes, RN facebook twitter Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Learn about our editorial process Kristin Hayes, RN Medically reviewed by Medically reviewed by John Carew, MD on March 20, 2020 twitter linkedin John Carew, MD, is board-certified in otolaryngology-head and neck surgery. He is an adjunct assistant professor at Mount Sinai Medical Center and NYU Medical Center. Learn about our Medical Review Board John Carew, MD on March 20, 2020 Print The esophagus is the tube of smooth muscle that moves food from the back of the throat (pharynx) to the stomach. A perforated esophagus is an esophagus that has ruptured or torn and now has a hole in it. This results in the leaking of food and sometimes even digestive fluid into the chest, and it can result in a serious infection. he perforated esophagus may be more common in men than in women and often occurs after binge eating. It is also more common for individuals who have an underlying disease of the esophagus including gastroesophageal reflux disease (GERD) or hiatal hernia. FatCamera / Getty Images Perforated Esophagus Symptoms Signs and symptoms of a perforated esophagus include: Difficulty swallowingVomiting or retching followed by severe chest painDifficulty breathingDifficulty speakingNeck pain, shoulder pain, upper or lower back pain. Discomfort may increase when lying down flatRapid breathing and heart rateFeverBloody vomit (rare)Subcutaneous emphysema (gas or air underneath the skin) especially in the neck and chest Perforation of the esophagus is fairly uncommon but can be quite serious, even deadly. Prompt treatment provides the best outcomes but unfortunately, treatment is often delayed due to misdiagnosis. A perforated esophagus is often confused with other conditions such as a heart attack, perforated peptic ulcers or acute pancreatitis. You need immediate medical attention if you suspect that you may have a perforated esophagus. Causes Causes of a perforated esophagus include: Procedures such as endoscopy, especially with dilation of the esophagus or esophageal strictures, during sclerotherapy, or variceal ligation. Other procedures including placement of an endotracheal tube, nasogastric tube, or Blakemore tube (rare). Individuals who are older than 65 years are also at increased risk.Ingestion of hazardous chemicals such as cleaners or disc batteriesIngestion of a foreign object (pills and coins are common culprits)Injuries such as gunshot or stab wounds, up to 10 percent of casesBoerhaave syndrome, a very rare condition in which the esophagus spontaneously ruptures usually as the result of violent vomiting or retching. (most common in individuals ages 40-60 years, accounts for about 15% of cases)Chronic esophageal conditions that cause thinning of the esophageal wallA complication of surgery including cardiothoracic surgery or fundoplication (rare)Tumors Surgical procedures used to be a significant cause of esophageal perforation but since the introduction of more flexible surgical instruments, the risk has decreased. Complications Complications of a perforated esophagus may include pneumonia, mediastinitis, sepsis, empyema, and acute respiratory distress syndrome (ARDS). The condition often requires surgery and antibiotics. A mild perforation in the upper portion of the esophagus may heal without surgery, but patients are often instructed not to eat or drink and may require nutrition from a feeding tube or IV until the esophagus heals. In some cases, an endoscopic procedure to place stents or clips can be used in this situation. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Raju GS. Esophageal perforations. Gastroenterol Hepatol (N Y). 2012;8(8):548–551. PMID:23293570 MedlinePlus Medical Encyclopedia. Esophageal perforation. Updated October 23, 2018. University of Maryland Medical System, "Esophageal Cancer" Mubang RN, Stawicki SP. Esophageal trauma. In: StatPearls.Updated March 1, 2019. Additional Reading Søreide JA, Viste A. 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