Perforation, or rather rupture of the esophagus, is a violation of the integrity of the esophagus that occurred against the background of an injury or spontaneously. In this state, there is only one help - an ambulance, since the gap poses a real threat to the patient's life. The problem can only be fixed with emergency surgery. As a last resort, if the patient is in the hospital and the tears are small, then conservative treatment is possible.
Statistics
This type of pathology is very rare, it is about 1% of all patients who enter the thoracic department. Perforation occurs three times more often in male patients. The disease is more common in people aged 50 years and older. Spontaneous rupture of the esophagus, or Boerhaave's syndrome, accounts for about 15% of all patients with perforation.
Disease classification
Pathology is usually divided according to the principle of occurrence:
- an independent nosological disease, including Boerhaave's syndrome;
- complication after another disease, injury or iatrogenic cause.
According to location:
- complete rupture of the esophagus, that is, perforation is localized throughout the thickness of the wall;
- incomplete perforation, that is, localized on one or more layers of the mucosa of the esophagus;
- internal or closed rupture, localization of perforation inside the esophagus;
- external open perforation with localization on the outer walls of the esophagus.
Although for both types of rupture, the symptoms of the manifestation of the disease are the same.
Mallory-Weiss syndrome, or fissure of the esophagus
Rupture of the esophagus has a similar pathology as a fissure of the stomach or esophagus. Cracks can be single, and can be located throughout the mucosa of the esophagus. Mallory-Weiss syndrome is not characterized by damage to connective tissues. Like tears, fissures are common in patients over the age of 50, males and alcohol abusers.
Reasons
Rupture of the esophagus most often occurs on the background of:
- frequent endoscopy;
- chemical burns;
- foreign bodies, especially sharp ones;
- trauma and penetrating wounds;
- with careless conduct of various operations, and as a result of an injury to the esophagus.
In rare cases, frequent vomiting or a strong and prolonged cough can lead to tears. Generic activity, or rather strong attempts can cause the disease. Against the background of an epileptic seizure, a gap may also occur.
Risk group
This group includes persons with the following pathologies:
- esophagitis;
- esophageal ulcer with profuse vomiting.
People with binge eating disorder are also at risk. Strong physical exertion or overexertion during defecation can lead to illness. At risk are also the male half of humanity from 50 years old.
Symptoms of the manifestation of the disease
In most cases, the clinical picture is characterized by a sharp onset of symptoms and manifests itself in the form of:
- sharp pain in the retrosternal and epigastric region;
- numbness of limbs;
- chest pain;
- pallor of the skin all over the body;
- dry cough that occurs out of the blue;
- increased salivation;
- tachycardia, shortness of breath;
- uncontrollable vomiting with splashes of blood, in time the vomit may look like coffee grounds;
- difficult and heavy breathing;
- profuse sweating;
- shock on the background of pain;
- there are signs of intoxication of the body;
- limbs and face may turn blue and cyanosis develops;
- rupture in the thoracic region may be characterized by mediastinitis;
- if the rupture is near the stomach, peritonitis may occur;
- air-filled emphysema in the face, neck.
Esophageal rupture symptoms require immediate medical attention. It is unfortunate, but in 50% of cases of perforation, patients die due to untimely seeking help.
The problem also lies in the fact that the symptoms of a gapcharacteristic of a number of other diseases and can cause pleurisy or heart attack. As a result, without adequate diagnosis and treatment, a person may simply die.
Diagnostic measures
If a rupture of the esophagus is suspected, diagnostic measures are carried out on an emergency basis. To begin with, a physical examination is performed, an anamnesis is clarified. Then blood is taken for biochemical and general analysis. X-rays and ultrasound are performed. Depending on the localization of pain, an X-ray examination of the chest is performed. Diagnosis also includes mediastinoscopy and pharyngoscopy.
X-ray examination is aimed at identifying fluid and air capsules in the pleura and abdominal cavity. To determine the location of the disease, a water-soluble contrast is first introduced into the esophagus, which, migrating, allows you to determine the location and size of damage to the esophagus.
Endoscopy is performed using a rigid endoscope so as not to inflate the esophagus with air.
Treatment measures
Treatment of a tear in the esophagus involves surgery.
Very rarely, but still used conservative treatment. Such measures are possible if the mucosa is damaged by no more than 1.5 cm. This may be damage to the esophagus with a fish bone or a biopsy needle, the main condition is the absence of damage to the mediastinal organs. In addition, the patient should not haveconcomitant symptoms, which is an indication for surgical intervention. In this case, active antibiotic therapy is used. Eating and drinking during treatment does not involve the introduction of food through the mouth. Antibiotics are administered to the patient several times a day and complete bed rest is put. If all the measures did not give a positive effect, then the operation will have to be carried out.
However, most often it is possible to “overcome” the disease and avoid death only with the participation of a surgeon. The main operational activities are aimed at:
- rapid closure of the gap;
- drainage of abscesses, if any, to prevent the development of peritonitis;
- temporary exclusion of the esophagus from the general digestive system.
After the operation, at least 2 days you can not eat food through the mouth. Feeding is carried out through a gastrostomy. Doctors inject a special nutrient solution.
If the patient's condition allows, then on the 3rd day the introduction of food begins in the usual way, but a dietary table is laid. The following products are allowed to be consumed:
- baked vegetables and fruits;
- porridge;
- mashed soups;
- jelly and compotes;
- meat and fish, only lean breeds, always baked or steamed;
- cottage cheese and meat puddings.
You will not eat flour products, including bread. It is forbidden to eat fried and fatty foods, conservation, acidic foods that can irritate the mucous membrane. Products containing dyes.
All products that can be consumed after surgery should be pureed or grated, brought to a warm state before taking them and consumed in small portions.
Possible Complications
The consequences of a ruptured esophagus can be devastating. An advanced form of the disease can cause the development of a purulent and inflammatory process, which will lead to damage to the fiber. The timeliness of treatment is a guarantee of eliminating the risk of adverse consequences and death.
Forecast and prevention
As in the presence of a rupture of the esophagus, Mallory-Weiss syndrome, the prognosis for recovery largely depends on the time interval between the start of treatment and the time of damage to the esophagus. An important role is played by the complications that accompany the pathology, the location and size of the gap, the general condition of the patient, and chronic diseases.
Preventive measures in this case play a secondary role. However, the exclusion of certain factors will prevent the development of the disease. You should avoid iatrogenic injuries, prevent your body from becoming bulimic, and undergo a medical examination in a timely manner.
It is necessary to follow some rules to minimize the risk of perforation. Teach children to always eat food slowly and chew it thoroughly. Often perforation occurs against the background of swallowing a large piece of food. Don't forget aboutthe saying "when I eat, I am deaf and dumb." Strong physical exertion, heavy lifting should be abandoned. Nutrition should be balanced and correct, alcohol should not be abused.
