Overview
Boerhaave syndrome describes the rupture of the oesophagus due to vomiting. Oesophageal ruptures may also occur following endoscopy or surgery in adjacent areas. Unlike Mallory-Weiss syndrome, in Boerhaave’s syndrome, the mucosa, submucosa, and muscular layer of the oesophagus are affected. The rupture generally occurs at the lower 1/3 of the oesophagus.
Risk Factors
Risk factors include conditions predisposing to retching and vomiting:
- Excessive alcohol consumption
- Gastroenteritis
- Hyperemesis gravidarum
- Bulimia nervosa
Presentation
Patients classically present with severe retrosternal/epigastric pain following retching and vomiting. The pain may be confused with cardiac causes such as myocardial infarction. Other features may be:
- Subcutaneous emphysema – crepitations under the skin due to free gas
- Signs of shock – tachycardia, tachypnoea
- Cyanosis
Investigations
Overview
- Chest x-ray:
- May show a widened mediastinum
- May show free mediastinal or peritoneal air
- CT scan with contrast swallow:
- The diagnostic test
Management
Overview
Treatment involves surgery with antibiotics to prevent sepsis. Even with early intervention, the mortality rate is as high as 25%.
