After instrumentation, perforation of the oesophagus is suspected if the patient complains of pain in the neck, chest or upper abdomen, together with dysphagia and pyrexia; this may not be evident immediately if the patient is sedated.
The sedated patient may suddenly become cyanosed and tachycardic. Surgical emphysema felt in the supraclavicular area supports the diagnosis.
Spontaneous rupture of the oesophagus is rare; it is associated with violent vomiting after a large meal. The patient has severe chest pain, and pain in the dorsal region of the spine or the upper abdomen. The patient is collapsed and cyanosed; the abdomen may be rigid and often a false diagnosis of perforated peptic ulcer is made.
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