Hamman’s crunch” is precordial crackles heard on auscultation | Surgery videos & books

Hamman’s crunch” is precordial crackles heard on auscultation that correlate with heart sounds in the setting of mediastinal emphysema and is suggestive of esophageal perforation. When present along with subcutaneous emphysema of the chest and neck, pneumomediastinum from an esophageal perforation is the most likely diagnosis. The most common cause of esophageal perforation is iatrogenic, but it may be spontaneous (Boerhaave’s syndrome) or secondary to a malignancy or stricture. Diagnosis is often made after clinical suspicion by endoscopy or a swallow study with water-soluble contrast. If diagnosed early (within 24 hours), a primary repair is the first approach to treatment. Closure is dependent on the amount of infected or necrotic tissue, tension on the anastomosis, etiology of the perforation, and the ability to adequately drain the contaminated areas. Late perforations may be complicated in their management, requiring several procedures or diversion to provide for adequate healing.