Boerhaave syndrome - case report

• Published in: São Paulo medical journal 2017-01, Vol.135 (1), p.71-75
• Main Authors: Dinic, Biljana Radovanovic, Ilic, Goran, Rajkovic, Snezana Tesic, Stoimenov, Tatjana Jevtovic
• Format: Article
• Language: English
• Subjects: Enfisema; Esophageal Perforation - diagnosis; Esôfago; Fatal Outcome; Female; Hematêmese; Humans; Mediastinal Diseases - diagnosis; MEDICINE, GENERAL & INTERNAL; Middle Aged; Pneumotórax; Ruptura espontânea; Rupture, Spontaneous - diagnosis
• ISSN: 1516-3180; 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2016.0095220616

Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus, usually in its distal part. It generally develops during or after persistent vomiting as a consequence of a sudden increase in intraluminal pressure in the esophagus. It is extremely rare in clinical practice. In 50% of the cases, it is manifested by Mackler's triad: vomiting, lower thoracic pain and subcutaneous emphysema. Hematemesis is an uncommon yet challenging presentation of Boerhaave's syndrome. Compared with ruptures of other parts of the digestive tract, spontaneous rupture is characterized by a higher mortality rate. This paper presents a 64-year-old female patient whose vomit was black four days before examination and became bloody on the day of the examination. Her symptoms included epigastric pain and suffocation. Physical examination showed hypotension, tachycardia, dyspnea and a swollen and painful abdomen. Auscultation showed lateral crackling sounds on inspiration. Ultrasound examination showed a distended stomach filled with fluid. Over 1000 ml of fresh blood was extracted by means of nasogastric suction. Esophagogastroduodenoscopy was discontinued immediately upon entering the proximal esophagus, where a large amount of fresh blood was observed. The patient was sent for emergency abdominal surgery, during which she died. An autopsy established a diagnosis of Boerhaave syndrome and ulceration in the duodenal bulb. Boerhaave syndrome should be considered in all cases with a combination of gastrointestinal symptoms (especially epigastric pain and vomiting) and pulmonary signs and symptoms (especially suffocation).