What Is an Esophagus Tear?

An esophageal tear is a tear in the esophagus—a tube that connects the mouth and throat to the stomach. Also known as an esophageal rupture or perforation, it's a potentially life-threatening condition.

Esophageal tears can be caused by severe vomiting, foreign objects, caustic substances, and surgical injuries. People with gastroesophageal reflux disease (GERD) or a hiatal hernia are at greater risk of esophageal tears.

This article discusses different types of esophagus tears, symptoms, causes, and complications. It also details treatments for this potentially deadly internal injury.

Types of Esophageal Tears

An esophageal tear is a rupture, laceration, or perforation in the wall of the esophagus. The esophagus, also known as the feeding tube, is made of a combination of smooth (involuntary) muscles and striated (voluntary) muscles as well as layers of connective tissues, structural tissues, and mucus-secreting tissues.

Esophageal tears are categorized by their underlying cause. Types of esophageal tears include;

• Iatrogenic perforation: This is any type of esophageal tear that occurs as a result of any medical activity. This can happen as part of a diagnosis, treatment, medical error, or negligence.
• Boerhaave syndrome: This serious type of esophageal tear is commonly caused by severe vomiting. Anything that rapidly changes the pressure within the esophagus can cause this.
• Mallory-Weiss syndrome: This is a partial tear of the esophagus. It affects only the mucosal layer where the stomach and esophagus meet.

Esophageal tears can also be described as intraluminal or extraluminal. The lumen is the interior passageway of any tubular organ. While intraluminal tears occur from within the esophagus, extraluminal tears are caused by an injury outside of the esophagus.

Symptoms of an Esophagus Tear

Signs and symptoms of an esophageal tear include:

• Severe vomiting or retching, sometimes bloody
• Excruciating chest or upper abdominal pain
• Pain radiating to the left shoulder
• Difficulty swallowing (dysphagia)
  
• Pain with swallowing (odynophagia)
  
• A crunching, rasping sound called the Hamman's sign
• Rapid breathing (tachypnea)
• Shortness of breath (dyspnea)
• Rapid heartbeat (tachycardia)
  
• Difficulty speaking or voice changes
• Facial or neck swelling
• Bluish lips or skin due to the lack of oxygen (cyanosis)

An esophageal tear can mimic conditions such as a heart attack, acute pancreatitis (inflammation of the pancreas), and severe peptic ulcers (stomach ulcers). Unfortunately, because of this, treatment is sometimes delayed until the condition has rapidly worsened.

Possible Complications

An esophageal tear poses serious health concerns as it allows food or fluids to leak into the chest and cause potentially severe lung problems and infections, among other things.

With Boerhaave's syndrome, the spontaneous rupture of the esophagus is associated with a high risk of death even with treatment.

Possible complications of an esophageal tear include:

• Lung and chest infection, including pneumonia, abscesses, and mediastinitis (inflammation of the chest area between lungs)
  
• Permanent esophageal stricture (narrowing of the esophagus)
• Pulmonary effusion (fluid build-up in the space between the lung and chest wall)
• Sepsis (a potentially deadly inflammatory response to a whole-body infection)
  

If untreated, esophageal tears can rapidly worsen and even lead to death. Death from esophageal tears is often the result of sepsis and a rapid drop in blood pressure, leading to shock and major organ failure.

Causes

Esophageal tears are fairly uncommon but can be extremely severe. The causes of these tears can be broadly categorized as either being intraluminal or extraluminal.

Intraluminal Causes

Intraluminal causes of an esophageal tear include:

• Medical procedures, such as endoscopy, esophageal dilation, or the placement of an endotracheal tube
• Foreign bodies lodged in the esophagus
• Esophagitis (esophageal inflammation), including severe esophageal infections and Barrett's esophagitis
• Esophageal cancer
• Ingestion of caustic chemicals or substances
• Barotrauma (sudden, extreme changes in atmospheric pressure, such as can occur with scuba diving)
• Boerhaave syndrome
• Deterioration of the esophageal wall, such as caused by esophageal ulcers in people with AIDS and esophageal corrosion due to long-standing GERD
• Frequent vomiting (e.g., with bulimia or alcohol abuse)
  

Extraluminal Causes

Some extraluminal causes of an esophageal tear include:

• Penetrating stab or gunshot wound
• Blunt-force injuries, including car crashes
• Surgical injuries, such as can occur with cardiothoracic surgery or a hiatal hernia repair

Treatments

An esophagus tear in the neck area may heal on its own. However, you will not be able to eat or drink until it is healed, which means you will need a feeding tube. 

Depending on the location and size of the esophagus tear, surgery may be required. Tears in the middle and bottom parts of the esophagus will require more extensive treatments. If the tear is small and the leaking is minimal, your surgeon may plug the hole with a stent. More severe tears may be treated with a simple repair. In extreme cases, the esophagus may need to be removed. 

In most cases, a Mallory-Weiss tear will stop bleeding and begin to heal on its own. If treatment is needed, your surgeon may perform an endoscopy to give an injection, cauterize the bleeding area, or insert a clip to close the tear and stop the bleeding.

Other treatments for an esophagus tear include:

• IV fluids and antibiotics
• A chest tube to drain fluid around the lungs
• A mediastinoscopy to remove fluid that has collected in the area behind the breastbone and between the lungs 

Summary

An esophageal tear is a rupture, laceration, or perforation on the wall of the esophagus. While most cases are due to medical procedures that physically injure the esophagus, others are due to things like severe vomiting, foreign bodies, caustic substances, or cancer.

Esophageal tears can cause a cascade of symptoms easily mistaken for a heart attack or a severe peptic ulcer. These include extreme chest pain, rapid heartbeat, shallow breathing, radiating shoulder pain, shortness of breath, and vomiting.

If left untreated, esophageal tears can lead to sepsis, shock, and even death. Esophageal tears often require surgery and in extreme cases may require removal of the esophagus.

A Word From Verywell

Not all esophageal tears require surgical repair, but that doesn't mean they are any less serious. Because swallowing and eating cause the contraction of esophageal walls, even tiny tears can progressively become severe.

Surgery is almost always needed, particularly for tears in the middle or lower part of the esophagus.

If ever you experience severe vomiting accompanied by extreme chest pains and breathing problems, don't wait until the following day to get it looked at. Go to your nearest emergency room to have it looked at immediately.