A routine dinner with clients leads to an unexpected crisis for a 60-year-old salesman.
Become a subscriberThe quiet of my night on call was interrupted by the familiar chime of my pager. The message on the screen requested I come to the emergency room to evaluate a patient with chest pain. For a gastroenterologist, “chest pain” is a bit of an uncommon symptom; usually, such concerns go to cardiology. But sometimes people with chest pain have a GI cause for their troubles.
Lying down, Matt soon knew something was very wrong. The pain in his chest returned and started to become even more severe. His heart began beating uncomfortably fast and he broke out in a drenching sweat. He also noted that his neck seemed to hurt. Initially thinking he was having a heart attack, Matt called 911 for an ambulance. Upon arriving in the ER, the nurse doing his initial evaluation noted that he had a fever of 101 degrees Fahrenheit.
An esophageal tear is a life-threatening event. Untreated, it is almost always fatal. Air, saliva, and gastric contents can now leave the esophagus and enter the chest cavity, where none of them belong. The mediastinum is ordinarily a sterile space, but easily becomes infected when an esophageal rupture occurs. Once infection sets in, patients often develop septic shock with dire consequences.
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