What is Boerhaave’s syndrome?

Boerhaave’s syndrome 

It is the spontaneous rupture of the oesophagal wall due to forceful vomiting or retching. It is a relatively uncommon but serious and potentially fatal condition.

Clinical Features of Boerhaave’s syndrome:

• Complete transmural (full-thickness) laceration or perforation of the oesophagus, distinct from Mallory-Weiss syndrome, a non-transmural oesophagal tear also associated with vomiting.
• Repeated forceful vomiting followed by severe epigastric pain, pleural effusion and some sort of respiratory distress
• Perforation is almost always on Left side of the Lower oesophagus.
• Gastric contents enter the mediastinum and pleural cavity if one were to perform a pleural fluid aspirate; one is likely to aspirate gastric contents! Pneumomediastinum may be developed as well.
• Male > Female and typically between 50-70 years old
• Other clinical features that may suggest the diagnosis include odynophagia and surgical emphysema in the neck

 Causes Boerhaave’s syndrome:

• Vomiting (against a closed glottis) in eating disorders such as bulimia
• Rarely: Extremely forceful coughing - Obstruction by food

Diagnosis:

• Chest Radiographs show mediastinal gas, effusion, and later pneumothorax.
• Oesophagram is used to confirm the leak, first with water-soluble contrast, then barium if no leak demonstrated.

 Management:

• Early operation after appropriate resuscitation offers the best chance of survival.

Source:

• The Only MRCP Notes You’ll Ever Need 4th Edition; page: 209
• Harrison’s Principles of Internal Medicine 2 volumes 19th Edition; page: 1910
• Step Up to MRCP Review Notes for P1 & P2 By Dr Khaled El Magraby 1st Edition; page: 246