Boerhaave Syndrome

Michael T. Vest; Peter Dross

doi:10.7556/jaoa.2018.165

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Boerhaave Syndrome

Michael T. Vest and Peter Dross

Published/Copyright: November 1, 2018

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From the journal Journal of Osteopathic Medicine Volume 118 Issue 11

Keywords: boerhaave syndrome; esophagus; critical care

An 86-year-old man with a history of dementia presented to an emergency department with 2 weeks of worsening nausea and vomiting. His vomiting became “violent” and was associated with chest pain and shortness of breath 1 hour before presentation. A computed tomographic (CT) scan of his chest showed pneumomediastinum (image A, arrow). He was endotracheally intubated and treated with a fentanyl infusion titrated to comfort, piperacillin/tazobactam, and intravenous fluids. A water-soluble contrast swallow study obtained by repositioning his orogastric tube into his esophagus demonstrated contrast extravasation from the distal esophagus into the mediastinum consistent with a perforation (image B, arrow). Because of concerns about quality of life if he were to survive this critical illness, surgical repair was not done. The patient was extubated and provided with comfort care and died soon after presentation.

Boerhaave syndrome (spontaneous rupture of the esophagus) often requires surgical intervention, and delay in diagnosis is associated with worse outcomes.¹ Vomiting and chest pain are classic symptoms, and subcutaneous emphysema may be noted on examination.² Findings on CT scan can be suggestive; however, a swallow study is essential to identify the site of perforation.

From the Department of Medicine at the Christiana Care Health System in Newark, Delaware, and the Sidney Kimmel Medical College at Philadelphia University and Thomas Jefferson University in Pennsylvania (Dr Vest) and the Department of Radiology at Christiana Care Health System in Newark, Delaware (Dr Dross).

Financial Disclosures: None reported.

Support: None reported.

^*Address correspondence to Michael T. Vest, DO, Christiana Care Health System, 4745 Ogletown-Stanton Rd, Newark, DE 19713-8002. Email: mvest@christianacare.org

References

1. Lindenmann J , MatziV, NeuboeckN, et al. Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm. J Gastrointest Surg.2013;17(6):1036-1043. doi:10.1007/s11605-012-2070-8Search in Google Scholar PubMed

2. He X , HeZ, LiH. Boerhaave syndrome: challenges in diagnosis and treatment of the early presentation and its complication. J Trauma Acute Care Surg. 2018;84(6):1030-1032. doi:10.1097/TA.0000000000001830Search in Google Scholar PubMed

Received: 2017-04-22

Accepted: 2017-04-26

Published Online: 2018-11-01

Published in Print: 2018-11-01

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

https://doi.org/10.7556/jaoa.2018.165

Keywords for this article

boerhaave syndrome; esophagus; critical care

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