Ear, Nose & Throat ENT Disorders Esophagus Tear: What Happens, Signs, and Causes Also Called Esophageal Ruptures or Perforation By Kristin Hayes, RN 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 Updated on May 26, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John Carew, MD Medically reviewed by John Carew, MD LinkedIn Twitter John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Types of Esophageal Tears Symptoms Complications Causes Frequently Asked Questions 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. FatCamera / Getty Images 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) Symptoms of an esophageal tear mimic those of other conditions, such as a heart attack, acute pancreatitis (inflammation of the pancreas), and severe peptic ulcers (stomach ulcers). Because of this, treatment is sometimes delayed until the condition has rapidly worsened. 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) Death from esophageal tears is often the result of sepsis and a rapid drop in blood pressure, leading to shock and major organ failure 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 According to a 2017 review published in Diseases of the Esophagus, 46.5% of all esophageal tears are the result of diagnostic and therapeutic procedures, such as an esophageal endoscopy. 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. Frequently Asked Questions Can a tear in your esophagus heal itself? A tear in the uppermost part of the esophagus near the neck may heal itself if you do not eat or drink for a period of time. In such cases, you will need a stomach feeding tube to get nutrition until the tear adequately heals. A tear in the middle or bottom portions almost invariably requires surgery. How do you fix a torn esophagus? Surgery is almost always needed to repair an esophagus tear. Antibiotics may be used to prevent infection, while intravenous fluids and parenteral feeding may be needed to maintain hydration and nutrition. Can you die from an esophageal tear? With certain types of esophageal tears, such as Boerhaave syndrome, the risk of death is nearly 100% if left untreated. Even when treated, the risk of death is around 25% if treatment is delivered within 24 hours. How long does an esophageal tear take to heal? It depends on the severity of the tear and the type of surgery used. With partial tears, such as occurs with Mallory-Weiss syndrome, the injury can often heal within 72 hours of treatment. Other tears can take weeks or even months to heal. 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 11 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. Esophagus disorders. Tullavardhana T. Iatrogenic esophageal perforation, J Med Assoc Thai. 2015 Oct;98 Suppl 9:S177-83. Tamatey NM, Sereboe LA, Tettey NM, Entsua-Mensah K, Gyan B. Boerhaave's syndrome: diagnosis and successful primary repair one month after the oesophageal perforation. Ghana Med J. 2013 Mar;47(1):53–55. Li H, Li ZB, Zhu HD, Wu XL, Tian DA, Li PY. The prediction value of scoring systems in Mallory-Weiss syndrome patients. Medicine (Baltimore). 2019 May;98(22):e15751. doi:10.1097/MD.0000000000015751 Eroglu A, Aydin Y, Yilmaz O. Minimally invasive management of esophageal perforation. Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Jul;26(3):496–503. doi:10.5606/tgkdc.dergisi.2018.15354 Hayakawa S, Ogawa R, Ito S, et al. Suitable diagnosis and treatment of esophageal ruptures in cases of non-Boerhaave syndrome: a comparison with Boerhaave syndrome. J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211014683. doi:10.1177/23247096211014683 MedlinePlus. Esophageal perforation. Sdralis EIK, Petousis S, Rashid F, et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus. 2017;30:1-6. doi:10.1093/dote/dox013 MedlinePlus. Esophageal perforation. Tejani N, Bowditch S, Engstad K, Ranasinghe L. An unusual case of esophageal rupture. J Clin Case Rep Case Stud. 2018:19-22:CCCS-101015. doi:https://10.29199/2637-9309/CCCS-101015 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