A oesophageal rupture may iatrogenic in endoscopic or other instrumental interventions or spontaneously (Boerhaave syndrome) occur. The patients are seriously ill, with symptoms of mediastinitis. The diagnosis is made by a Ösophagographie with a water soluble contrast agent. Immediate surgical intervention and drainage are necessary.
A oesophageal rupture may iatrogenic in endoscopic or other instrumental interventions or spontaneously (Boerhaave syndrome) occur. The patients are seriously ill, with symptoms of mediastinitis. The diagnosis is made by a Ösophagographie with a water soluble contrast agent. Immediate surgical intervention and drainage are necessary.
(P a. Overview of esophageal dysphagia.) A oesophageal rupture may iatrogenic in endoscopic or other instrumental interventions or spontaneously (Boerhaave syndrome) occur. The patients are seriously ill, with symptoms of mediastinitis. The diagnosis is made by a Ösophagographie with a water soluble contrast agent. Immediate surgical intervention and drainage are necessary. Endoscopic procedures are the main cause oesophageal rupture can occur next to a spontaneous rupture, typically vomiting, choking or swallowing a giant food bolus. Most frequently the distal esophagus ruptured on the left side. Acid and other stomach contents cause fulminant mediastinitis and shock. A pneumomediastinum is frequent. Symptoms and signs The symptoms of oesophageal rupture include chest and abdominal pain, vomiting, blood vomiting and shock. Subcutaneous emphysema can be palpated in 30% of patients. In addition, a mediastinales crunch can (Hamman-mark), a synchronous with the heartbeat crackling exist. Diagnostic X-rays of the chest and abdomen Ösophagographie radiographs of the chest and abdomen with air in the mediastinum, with pleural effusion and widening of the mediastinum are suggestive of rupture. The diagnosis of oesophageal rupture is confirmed by the Ösophagographie with water-soluble contrast medium with which one avoids potential mediastinal irritation caused by barium. A CT of the chest shows air or liquid in the mediastinum, but can locate the perforation not good. At endoscopy can overlook a small perforation. Therapy Endoscopic stenting or surgical ligation. During the discussion related surgery or endoscopic stenting, patients should receive broad-spectrum antibiotics fluid replacement according to the symptoms of shock (eg. As gentamicin plus metronidazole or piperacillin / tazobactam) and. Even with appropriate treatment, there is a high mortality.