No history of previous illness but with an ambiguous reference to recent food and drink overindulgence, was presented to Emergency department complaining of the sudden onset of gradually increasing, lower thorax post emetic pain and subcutaneous emphysema.
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The suspicion of spontaneous esophageal rupture was confirmed on CT scan and esophagogram by the presentation of bilateral pleural effusion together with right sided contrast extravasation from the lower third of the esophagus and pneumomediastinum.
Boerhaave syndrome is suspected on a clinical basis and confirmed with radiologic studies. As gastric content passes to mediastinum and usually pleural space, a delay in diagnosis raises morbidity and mortality significantly.
Boerhaave syndrome is a spontaneous longitudinal perforation of the esophagus due to forceful emesis first described by Hermann Boerhaave in the 18th century.
This pathology is best treated with definitive repair and mediastinal and/or pleural drainage procedures.