Esophagus Tear: What Happens, Signs, and Causes

Also Called Esophageal Ruptures or Perforation

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.

Telling a Doctor About Her Sore Throat
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:

Extraluminal causes of an esophageal tear include:

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?
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.
  1. Raju GS. Esophageal perforations. Gastroenterol Hepatol (N Y). 2012;8(8):548–551. PMID:23293570

  2. MedlinePlus. Esophagus disorders.

  3. Tullavardhana T. Iatrogenic esophageal perforation, J Med Assoc Thai. 2015 Oct;98 Suppl 9:S177-83.

  4. 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.

  5. 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

  6. 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

  7. 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

  8. MedlinePlus. Esophageal perforation.

  9. 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

  10. MedlinePlus. Esophageal perforation.

  11. 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