Boerhaave syndrome

Case contributed by Dr Huy Sruy

Presentation

Intoxicated man came in with shock after forceful vomiting.

Patient Data

Age: 50 years
Gender: Male
X-ray

Left pleural effusion with alveolar opacity of left lower lobe. Pneumomediastinum and gastric distension.

CT

The study shows extensive peri-esophageal posterior mediastinal air collection, a ruptured distal esophagus is suggested. There is also a left pneumothorax, pneumomediastinum, bilateral pleural effusion prominent on the left side, and subcutaneous emphysema. 

 

Barium

The barium swallow after surgery (thoracothomy with esophageal repair and muscular flap) reveals:

Normal swallowing and normal esophageal peristalsis.

No evidence of contrast leakage.

Case Discussion

Boerhaave syndrome is perforation of the esophagus caused by forceful vomiting because of increasing intra-oesophagal pressure combined with relatively negative intra-thoracic pressure.

This syndrome is associated with Mackler's triad (vomiting, chest pain, and subcutaneous emphysema). 

Chest x-ray and CT chest help to confirm the diagnosis of Boerhaave syndrome and should be considered immediately in suspected patients.

Special thanks to professor Anuchit Ruamthanthong.

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Case information

rID: 59796
Published: 4th May 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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