Perforation of the esophagus occuring generally in a context of repeated efforts of vomiting after a heavy meal. The spontaneous rupture is generally located in the lower 1/3 of the thoracic esophagus and more often on the left side, posteriorly. The tear causes severe epigastric pain, occasionally reported in the left shoulder and, usually, subcutaneous emphysema. X-ray: pneumomediastinum, pleural effusion.

It is a rare cause of perforation of the esophagus. Other causes of traumatic esophageal perforation are: ingestion of a sharp foreign body, dilatation of esophageal stenosis or achalasia, sclerosis of esophageal varices, and transesophageal echocardiography. The perforation may occur at any level of the esophagus even if the esophageal  inlet is the most at risk area.

The basis of treatment is a classic medical resuscitation with broad-spectrum antibiotics against gram (-) and anaerobic bacilli to treat mediastinitis. Some antacids are also necessary to prevent an additional caustic factor.

Most cases require surgery in emergency (antero-lateral thoracotomy) to repair the tear, and if necessary perform a gastrostomy to exclude the esophagus, to clean the mediastinum and drain the effusions.
If the diagnosis is late, a phase of intensive care preparation is fundamental to bring the patient in the operating room in good condition. 

Anesthetic implications: 

early sepsis, hypovolemia, full stomach. need for one-lung ventilation

References : 

Updated: November 2019