Esophageal Injury
Damage to the tube that carries food to the stomach
Quick Facts
- Type: Digestive (gastrointestinal) condition
- Common causes: Swallowed objects, caustic substances, procedures, vomiting
- Most serious form: Perforation (a full tear through the wall)
- Seek urgent care: Severe chest pain, fever, trouble swallowing or breathing
Overview
The esophagus is the muscular tube that moves food and liquid from the throat down to the stomach. An esophageal injury is any damage to this tube, which can range from a minor surface tear or burn to a perforation, a complete hole through the wall. Because the esophagus passes close to the heart, lungs, and major vessels, a full-thickness injury can let saliva, food, and bacteria leak into the chest, causing severe infection.
Esophageal injuries can result from swallowing sharp objects or harmful chemicals, from forceful vomiting, from medical procedures, or from external trauma. Minor injuries often heal on their own, but a perforation is a medical emergency that needs urgent treatment to prevent life-threatening complications.
Symptoms
Symptoms vary with the severity and location of the injury. A full tear usually causes sudden, severe symptoms.
- Pain in the chest, neck, or upper back
- Pain or difficulty swallowing
- Vomiting, sometimes with blood
- Fever and a rapidly ill appearance
- Shortness of breath or rapid breathing
- Swelling or a crackling feeling under the skin of the neck or chest
Sudden severe chest pain after vomiting or a procedure, especially with fever or trouble breathing, is an emergency. Call emergency services right away.
Causes
The esophagus can be injured from the inside or from external force.
- Medical procedures: Endoscopy, dilation of a narrowing, or tube placement can occasionally tear the wall; this is the most common cause of perforation.
- Forceful vomiting: Violent retching can rupture the lower esophagus, sometimes called Boerhaave syndrome.
- Swallowed objects or chemicals: Sharp items, button batteries, or caustic substances such as drain cleaner can burn or tear the lining.
- Trauma: Penetrating wounds or severe blunt injury to the neck or chest.
- Severe inflammation: Ulcers, infections, or cancer can weaken the wall.
Risk Factors
- Recent endoscopy or dilation of an esophageal narrowing
- Severe or repeated vomiting
- Swallowing caustic chemicals or sharp foreign objects (a particular concern in young children)
- Existing esophageal disease, such as a stricture, ulcer, or cancer
- Penetrating neck or chest trauma
Diagnosis
Prompt diagnosis is important because outcomes worsen with delay.
- CT scan of the chest and neck: Often the first test, showing leaks of air or fluid outside the esophagus.
- Contrast swallow study: X-rays taken while swallowing a contrast liquid can pinpoint a leak.
- Endoscopy: Direct viewing of the lining to find tears or burns.
- Chest X-ray: May show air in the chest or fluid collections.
Treatment
Treatment depends on the type and severity of the injury, how soon it is found, and the person's overall condition.
- Resting the esophagus: Stopping food and drink by mouth, with nutrition given another way, lets minor injuries heal.
- Antibiotics: Used to prevent or treat infection from leaked contents.
- Endoscopic repair: Stents, clips, or other tools placed through an endoscope can seal some tears.
- Surgery: A perforation, especially if found late or large, often requires an operation to repair the wall and drain infection.
A perforation is treated urgently, because leakage into the chest can quickly become life-threatening.
Prevention
- Keep caustic chemicals and button batteries locked away from children
- Chew food well and be cautious with bones and hard items
- Seek treatment for swallowing problems or known esophageal narrowing
- Tell your care team about any severe pain after an endoscopy or dilation
- Manage conditions that cause repeated vomiting
When to See a Doctor
See a doctor for ongoing painful or difficult swallowing, or after swallowing a sharp object or chemical. Seek emergency care immediately for:
- Sudden severe chest, neck, or back pain, especially after vomiting or a procedure
- Vomiting blood
- Fever with trouble swallowing or breathing
- Swelling or a crackling sensation in the neck or chest
If a child has swallowed a button battery, treat it as an emergency and go to the hospital without delay.
Frequently Asked Questions
What is the most serious type of esophageal injury?
A perforation, which is a complete hole through the wall of the esophagus, is the most serious. It lets saliva, food, and bacteria leak into the chest and can cause a severe, life-threatening infection, so it requires emergency treatment.
What causes an esophageal tear?
Common causes include medical procedures such as endoscopy, forceful vomiting, swallowing sharp objects or caustic chemicals, and trauma to the neck or chest. Existing esophageal disease can make the wall more fragile.
Can an esophageal injury heal on its own?
Minor tears and irritation often heal when the esophagus is rested by avoiding food and drink for a time, sometimes with antibiotics. A full perforation usually needs endoscopic repair or surgery and cannot be left to heal alone.
Why are button batteries so dangerous to swallow?
A button battery lodged in the esophagus can burn through the wall within hours, especially in children. This is a medical emergency, and a child who has swallowed one should be taken to the hospital immediately.
What are the warning signs of an esophageal perforation?
Sudden severe chest, neck, or back pain, particularly after vomiting or a procedure, along with fever, trouble swallowing or breathing, or swelling and crackling under the skin of the neck. These require calling emergency services.
References
- Mayo Clinic. Esophageal disorders.
- MedlinePlus, U.S. National Library of Medicine. Esophagus disorders.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Digestive Diseases.
- National Library of Medicine. StatPearls: Esophageal Perforation.