The spectrum of spontaneous and iatrogenic esophageal injury - Perforations, Mallory-Weiss tears, and hematomas

Esophageal perforations, Mallory-Weiss tears, and esophageal hematoma invol ve traumatic injury to the esophagus. These can be iatrogenic, in particula r due to esophageal instrumentation, bur can also occur spontaneously. The remarkable increase in diagnostic and therapeutic endoscopy as well as esop hageal surgery has made instrumentation the most common cause of esophageal perforation. In many instances, spontaneous perforations are associated wi th retching and vomiting, which causes a sudden increase in intraesophageal pressure. A high index of suspicion leading to rapid diagnosis and appropr iate therapy are needed to optimize clinical outcomes. This article focuses on esophageal perforations, Mallory-Weiss tears, and esophageal hematomas, with emphasis on etiology, pathogenesis, clinical presentation, diagnosis, management, and prevention.