Pain may radiate to the neck. Hematemesis usually is not profuse. Iatrogenic perforation usually occurs during a procedure and may be at any point in the esophagus. Although usually detected at time of injury, delayed presentation is reported. This sign takes at least an hour to develop after injury.
Patients usually appear acutely ill, having tachycardia and tachypnea.
Depending on the length of time to presentation, patients may have a fever. If a delay in presentation or diagnosis has occurred, patients may present hypotensive and septic. Examination of chest may reveal decreased breath sounds on the side of perforation, usually the left side. Direct trauma causing injury to esophagus is often secondary to gunshot wounds and frequently is associated with injury to trachea and spinal cord. No lab studies are diagnostic.