From the Guidelines
The most common location for esophageal rupture is the left border of the lower third of the thoracic esophagus. This is based on the strongest and most recent evidence from the World Journal of Emergency Surgery, which states that spontaneous esophageal perforation (Boerhaave syndrome) is most often due to an abrupt increase in the esophageal pressure following a vomiting effort, and the tear is usually located on the left border of the lower third of the thoracic esophagus 1.
Key Points
- The left border of the lower third of the thoracic esophagus is the most common location for esophageal rupture, with a large wall defect (3–8 cm) 1.
- The majority of esophageal perforations (60%) are iatrogenic and occur during diagnostic and therapeutic endoscopic procedures 1.
- Other causes of rupture include operative and external trauma, malignancy, foreign bodies, and caustic ingestion, but the left border of the lower third of the thoracic esophagus remains the most susceptible to full-thickness tears.
Clinical Implications
- Mortality of esophageal perforation ranges between 10% and 20%, and the delay in treatment is the most important survival predictor 1.
- Timely diagnosis and appropriate treatment are crucial to prevent severe sepsis and death.
- The contamination of surrounding spaces with digestive contents is a common denominator of all esophageal perforations, regardless of the cause.
From the Research
Esophageal Rupture Location
The most common location for esophageal rupture is not explicitly stated in the provided studies. However, the studies do provide information on the locations of esophageal perforations:
- A study published in 2004 2 found that esophageal perforations occurred in the:
- Cervical esophagus in 12 cases
- Thoracic esophagus in 13 cases
- Abdominal esophagus in 11 cases
- The other studies do not provide specific information on the location of esophageal ruptures.
Symptoms and Diagnosis
The symptoms of esophageal rupture, also known as Boerhaave's syndrome, include:
- Severe chest pain
- Vomiting
- Subcutaneous emphysema (air under the skin) 3, 4
- Dyspnea (difficulty breathing)
- Fever
- Abdominal pain 3
Early diagnosis is crucial for improving patient outcomes, and primary repair is often possible if diagnosed promptly 5, 2.