Perforation, or rather rupture of the esophagus is a violation of the integrity of the esophagus that occurred on the background of an injury or spontaneously. In this state, there is only one help - ambulance, since the gap carries a real threat to the patient's life. It is possible to fix the problem only by emergency surgical intervention. In extreme cases, if the patient is in the hospital, and the gaps are small, then conservative treatment is possible.
Statistics
This type of pathology is very rare, it is about 1% of all patients who fall into the thoracic department. Perforation is three times more common in male patients. The disease is more common in people aged 50 years and older. Spontaneous rupture of the esophagus, or Burhave syndrome, accounts for about 15% of all patients with perforation.
Disease classification
Pathology is usually divided according to the principle of occurrence:
- independent nosological disease, including Burhave syndrome;
- complication after another disease, injury or iatrogenic causes.
At the place of localization:
- complete rupture of the esophagus, that is, perforation is localized throughout the wall thickness;
- incomplete perforation, that is, localized on one or more membranes of the mucous membrane of the esophagus;
- internal or closed rupture, localization of perforation inside the esophagus;
- external open perforation with localization on the external walls of the esophagus.
Although for both types of rupture, the symptomatology of the manifestation of the disease is the same.
Mallory-Weiss Syndrome, or Esophageal Fissure
A rupture of the esophagus has a similar pathology, like a rupture of the stomach or esophagus. Cracks can be single, but can be located throughout the mucous membrane of the esophagus. Mallory-Weiss syndrome is not characterized by damage to the connective tissue. Like ruptures, cracks are typical for patients over the age of 50, male and abusing alcohol.
Causes
Esophageal rupture most often occurs against the background of:
- frequent endoscopic examinations ;
- chemical burns;
- ingress of foreign bodies, especially acute;
- injuries and penetrating wounds;
- with careless carrying out various operations, and as a result of an esophageal injury.
In rare cases, frequent vomiting or a strong and prolonged cough can lead to tears. Labor 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 people with the following pathologies:
- esophagitis;
- esophageal ulcer with profuse vomiting.
People with uncontrolled overeating syndrome are also at risk. The disease can lead to extreme physical exertion or overstrain during bowel movements. At risk are also the male half of humanity from 50 years.
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 sternum and epigastric region;
- numbness of the limbs;
- chest pain;
- pallor of the skin throughout the body;
- dry cough that occurs out of the blue;
- increased salivation;
- tachycardia, shortness of breath;
- indomitable vomiting with a splash of blood, over time, the vomit may resemble coffee grounds;
- labored and heavy breathing;
- profuse sweating;
- shock on the background of pain;
- signs of intoxication appear;
- limbs and face can turn blue, and cyanosis develops;
- a rupture in the thoracic region may be characterized by mediastinitis;
- if a rupture is near the stomach, peritonitis may occur;
- emphysema, filled with air, in the face, neck.
Symptoms of rupture of the esophagus 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 plane that rupture symptoms are also characteristic of a number of other diseases and can cause pleurisy or heart attack. As a result, without adequate diagnosis and treatment, a person can simply die.
Diagnostic measures
If you suspect a rupture of the esophagus, diagnostic measures are carried out on an emergency basis. To begin with, a physical examination is performed, an anamnesis is found out. Then blood is taken for biochemical and general analysis. X-ray examination and ultrasound. Depending on the location of the pain, an x-ray 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, previously introduced into the esophagus is a water-soluble contrast, which, migrating, allows you to determine the location and extent of damage to the esophagus.
Endoscopy is performed using a rigid endoscope so as not to inflate the esophagus with air.
Therapeutic measures
Treatment for rupture of the esophagus involves surgical intervention.
Very rarely, but still conservative treatment is used. Such measures are possible if the mucous membrane 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 have concomitant symptoms, which is an indication for surgery. In this case, active antibiotic therapy is used. Eating and drinking during treatment does not imply oral administration of food. Antibiotics are administered to the patient several times a day and a full bed rest is laid. If all the activities did not give a positive effect, then you will have to carry out the operation.
However, most often "overcome" the disease and avoid death is possible only with the participation of the surgeon. The main operational activities are aimed at:
- early 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 surgery, at least 2 days should not be eaten by mouth. Nutrition is carried out through the gastrostomy. Doctors administer 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 for use:
- baked vegetables and fruits;
- cereals;
- mashed soups;
- jelly and stewed fruit;
- meat and fish, only non-fat breeds, always baked or steamed;
- cottage cheese and meat puddings.
You will not be able to eat flour products, including bread. It is forbidden to eat fried and fatty foods, preservation, acidic foods that can irritate the mucous membrane. Products containing dyes.
All products that can be consumed after surgery should have a puree consistency or be grated, before taking them, they must be brought to a warm state and consumed in small portions.
Possible complications
The consequences of a rupture of the esophagus can be horrific. A neglected form of the disease can cause the development of a purulent and inflammatory process, which will lead to damage to the fiber. Timeliness of treatment is a guarantee of eliminating the risk of developing harmful consequences and the onset of 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 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. Iatrogenic damage should be avoided, your body should not be allowed to have bulimia, and a medical examination should be done in a timely manner.
Some rules must be followed to minimize the risk of perforation. Teach children to always eat food slowly, chew it thoroughly. Perforation often occurs when a large chunk of food is swallowed. Do not forget the saying "when I eat, I am deaf and him." You should abandon strong physical exertion, from lifting weights. Nutrition should be balanced and proper, alcohol should not be abused.