Esophagus Tear: What Happens, Signs, and Causes

An esophageal tear is a tear in the tube that connects the mouth and throat to the stomach, known as the esophagus. Also referred to as an esophageal rupture or perforation, it is a potentially life-threatening condition that requires prompt diagnosis and emergency treatment.

There are many possible causes of an esophageal tear, including severe vomiting, foreign objects, caustic substance, and surgical injuries. Certain people are at greater risk of esophageal tears, including those with gastroesophageal reflux disease (GERD) or hiatal hernial. If left untreated, esophageal tears can rapidly worsen and even lead to death.

This article looks at the symptoms and causes of an esophageal tear and some of the complications that can result from this potentially deadly internal injury.

Types of Esophageal Tears

An esophageal tear is a rupture, laceration, or perforation in the wall of the esophagus. The esophagus, also known as the feeding tube, is made of a combination of smooth (involuntary) muscles and striated (voluntary) muscles as well as layers of connective tissues, structural tissues, and mucus-secreting tissues.

There are several different types of esophageal tears that are categorized by their underlying cause. These include;

• Iatrogenic perforation: This is any type of esophageal tear that occurs as a result of any medical activity, including a diagnosis, treatment, medical error, or negligence.
• Boerhaave's syndrome: This is a serious type of esophageal tear caused by severe vomiting and other events that rapidly change the pressure within the esophagus.
• Mallory-Weiss syndrome: This is a partial tear affecting only the mucosal layer at the junction of the stomach and esophagus.

Esophageal tears can also be described as being intraluminal or extraluminal tears. The lumen is the interior passageway of any tubular organ. An intraluminal tear, therefore, is one that occurs from within the esophagus, while an extraluminal tear is one that occurs from an injury outside of the esophagus.

Esophageal Tear Symptoms

An esophageal tear poses serious health concerns as it allows food or fluids to leak into the chest and cause potentially severe lung problems and infections, among other things.

Signs and symptoms of an esophageal tear include:

• Severe vomiting or retching, sometimes bloody
• Excruciating chest or upper abdominal pain
• Pain radiating to the left shoulder
• Difficulty swallowing (dysphagia)
  
• Pain with swallowing (odynophagia)
  
• A crunching, rasping sound called the Hamman's sign
• Rapid breathing (tachypnea)
• Shortness of breath (dyspnea)
• Rapid heartbeat (tachycardia)
  
• Difficulty speaking or voice changes
• Facial or neck swelling
• Bluish lips or skin due to the lack of oxygen (cyanosis)

Complications

An esophageal tear is considered a medical emergency in need of immediate treatment. If left untreated, even minor tears can worsen and rapidly increase in size and severity.

With Boerhaave's syndrome, the spontaneous rupture of the esophagus is associated with a high risk of death even with treatment.

Possible complications of an esophageal tear include:

• Lung and chest infection, including pneumonia, abscesses, and mediastinitis (inflammation of the chest area between lungs)
  
• Permanent esophageal stricture (narrowing of the esophagus)
• Pulmonary effusion (fluid build-up in the space between the lung and chest wall)
• Sepsis (a potentially deadly inflammatory response to a whole-body infection)
  

Causes

Esophageal tears are fairly uncommon but can be extremely severe. The causes of these tears can be broadly categorized as either being intraluminal or extraluminal.

Intraluminal causes of an esophageal tear include:

• Medical procedures, such as endoscopy, esophageal dilation, or the placement of an endotracheal tube
• Foreign bodies lodged in the esophagus
• Esophagitis (esophageal inflammation), including severe esophageal infections and Barrett's esophagitis
• Esophageal cancer
• Ingestion of caustic chemicals or substances
• Barotrauma (sudden, extreme changes in atmospheric pressure, such as can occur with scuba diving)
• Boerhaave syndrome
• Prior esophageal surgery
• Deterioration of the esophageal wall, such as caused by esophageal ulcers in people with AIDS and esophageal corrosion due to long-standing GERD
  

Extraluminal causes of an esophageal tear include:

• Penetrating stab or gunshot wound
• Blunt-force injuries, including car crashes
• Surgical injuries, such as can occur with cardiothoracic surgery or a hiatal hernia repair

Summary

An esophageal tear is a rupture, laceration, or perforation on the wall of the esophagus. While most cases are due to medical procedures that physically injure the esophagus, others are due to things like severe vomiting, foreign bodies, caustic substances, or cancer.

Esophageal tears can cause a cascade of symptoms that are easily mistaken for a heart attack or a severe peptic ulcer. These include extreme chest pain, rapid heartbeat, shallow breathing, radiating shoulder pain, shortness of breath, and vomiting.

If left untreated, esophageal tears can lead to sepsis, shock, and even death.

A Word From Verywell

Not all esophageal tears require surgical repair, but that doesn't mean they are any less serious. Because swallowing and eating cause the contraction of esophageal walls, even tiny tears can become rapidly progressively and turn severe.

Surgery is almost always needed, particularly for tears in the middle or lower part of the esophagus.

If ever you experience severe vomiting accompanied by extreme chest pains and breathing problems, don't wait until the next morning to get it looked at. Go to your nearest emergency room to have it looked at immediately.