What is Boerhaave’s syndrome?


Boerhaave’s syndrome 

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

Clinical Features of Boerhaave’s syndrome:

  • Complete transmural (full-thickness) laceration or perforation of the esophagus, distinct from Mallory-Weiss syndrome, a non-transmural esophageal 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 Lower esophagus.
  • 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.
  • Esophagram is used to confirm 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
2- Step Up to MRCP Review Notes for P1 & P2 By Dr Khaled El Magraby 1st Edition; page: 246

Post a Comment

0 Comments