Overview
Definition
Spontaneous, transmural rupture of the esophagus, most commonly occurring in the left posterolateral distal esophagus, typically triggered by forceful vomiting.
Epidemiology
Rare, but high mortality rate (up to 20-40% even with intervention).
Etiology & Risk Factors
- Sudden rise in intraluminal esophageal pressure against a closed upper esophageal sphincter during retching or vomiting (associated with alcohol bingeing)
Clinical Symptoms
- Severe, sudden-onset retrosternal chest or abdominal pain
- Repeated vomiting followed by pain
- Subcutaneous emphysema (crepitus on chest palpation)
- Mackler's triad (Vomiting, Chest pain, Subcutaneous emphysema)
Clinical Approach
Diagnosis
- Esophagography using water-soluble contrast (Gastrografin) showing extravasation
- Chest CT showing mediastinal air/fluid
Management
- NPO, aggressive IV fluids, broad-spectrum antibiotics
- Urgent surgical repair/debridement (if within 24h) or endoscopic stenting
Complications
- Mediastinitis (severe, life-threatening infection)
- Sepsis / Septic shock
- Pleural effusion / Empyema