Table 3.

Clinical vignettes of individuals with esophageal perforation

Case #	Patient age (years)	Sex	Prior symptoms	Presentation/Course	Had surgery?	Final dx	EoE Dx known?	Assoc with food impaction?	Ever dilated prior?
1	25	Male	History of chronic dysphagia, heartburn	4 days of severe abdominal pain. CT showed paraesophageal abscess, no visible air. Barium swallow showed no contrast extravasation. Treated conservatively with IV antibiotics and bowel rest. Discharged after 8-day hospitalization.	No	Contained perforation	Yes	No	Yes
2	36	Female	Allergic rhinitis and sinusitis, dysphagia for 8–10 years	Presented with inability to swallow secretions after eating cereal. Had urgent endoscopy at outside center, during which food was dislodged and balloon dilation was performed. Returned 5 hours post-procedure with severe abdominal pain and chest pain. Negative barium swallow. CT Chest performed, showed pneumomediastinum. Treated with IV antibiotics and bowel rest. Discharged after 7-day hospitalization.	No	Transmural perforation	No	Yes	No
3	32	Male	Asthma, dysphagia, hx of food impactions.	Presented to ER with chest pain and hematemesis 3 hours after eating lettuce. Then vomited food and blood. Barium swallow showed intramural esophageal tear. Chest CT showed gas dissecting into wall of esophagus and bilateral pleural effusions. Treated with IV antibiotics and bowel rest. Discharged after 5-day hospitalization.	No	Transmural perforation	Yes	Yes	No
4	47	Male	History of asthma, esophageal perforation in past	Presented to ER with sore throat ×1 week, fever to 101° F for 1 day. CT demonstrated circumferential thickening of the distal esophagus with a loculated paraesophageal fluid collection. Treated with IV antibiotics, fluids, and bowel rest. Discharged home after 3-day hospitalization.	No	Contained perforation	Yes	No	Yes
5	43	Male	None	Presented to ER with 6 hours of abdominal pain, chest pain, after eating nachos. Barium swallow showed extravasation of contrast and moderate R pleural effusion. Taken to OR, underwent R thoracotomy with evacuation of empyema and primary closure of esophagus. Discharged after 11-day hospitalization.	Yes	Transmural perforation + empyema	No	Yes	No
6	19	Male	Childhood allergies to cats, dogs	Presented to ER with inability to swallow secretions 4 hrs after eating steak. Had EGD with disimpaction of food, but returned to ER with severe chest pain. Barium swallow negative for contrast extravasation. CT showed para-esophageal gas and pneumomediastinum. Treated with IV antibiotics and bowel rest. Discharged home after 7-day hospitalization.	No	Contained perforation	Yes	Yes	No
7	42	Male	Asthma, GERD	Presented to ER with chest pain and feeling that food was stuck, 8 hrs after eating chicken. EGD performed, food bolus removed piecemeal. Immediately post-procedure, had severe chest pain, crepitus. CXR showed pneumomediastinum with air tracking into neck. The pt. underwent left thoracotomy with primary closure of the esophagus. He was discharged home after 6-day hospitalization.	Yes	Transmural perforation	No	Yes	No
8	29	Female	None	Presented to ER with inability to swallow secretions after eating meat, passed after glucagon administration. Several days later, had routine outpatient EGD, scope unable to be passed. Perforation observed during procedure. Patient given IV antibiotics, bowel rest, and observed. Discharged after 5-day hospitalization.	No	Transmural perforation	No	Yes	No
9	33	Female	Seasonal allergies, GERD	Presented to ER with severe abdominal pain 15 hours after eating chicken, after several episodes of emesis. Barium swallow showed contrast extravasation and pneumomediastinum. Pt was taken to the OR for thoracotomy; had primary closure of the esophagus. Discharged after 12-day hospitalization.	Yes	Transmural perforation	No	Yes	No
10	28	Male	None	Presented to outside ER with severe chest and epigastric pain ×3–4 hours after eating a piece of pot roast. CXR showed pneumomediastinum. Patient emergently transferred for surgical evaluation. Underwent a left thoracotomy with T-tube repair of esophagus. Discharged after 9-day hospitalization.	Yes	Transmural perforation	Yes	Yes	No