Pain may radiate to neck. Hematemesis usually is not profuse. Iatrogenic perforation usually happens during a procedure and may occur 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, with tachycardia and tachypnea.
Depending upon length of time to presentation, patient may or may not have a fever. If a delay in presentation or diagnosis has occurred, patient may present hypotensive and septic. Examination of chest may reveal decreased breath sounds on side of the 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.