Risk factors for esophageal perforation during endoscopy:
(1) use of a rigid endoscope
(2) difficult intubation
(3) inexperienced endoscopist
(4) uncooperative patient (perhaps indicating inadequate sedation)
(5) elderly frail patients with abnormal anatomy
(6) therapeutic endoscopy (dilatation, etc) or biopsy
(7) presence of a Zenker's diverticulum
Clinical findings:
(1) pain
(2) dyspnea
(3) cyanosis
(4) dysphagia
(5) fever and tachycardia
(6) subcutaneous emphysema
(7) infection
|
Site of Perforation
|
Site of Pain
|
|
upper
|
neck and upper thorax
|
|
lower
|
lower thorax or epigastrium with radiation to the scapular region
|
Imaging studies:
(1) air in the mediastinum
(2) mediastinal widening
(3) pleural effusion
(4) pneumothorax
(5) leakage of swallowed contrast medium
