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Bhojani F, Shafqat G, Zafar U, Khan A. 'Bubbles and esophagus: A tale of unexpected and otherwise unexplained pain'. Radiol Case Rep 2024; 19:2043-2047. [PMID: 38444597 PMCID: PMC10914552 DOI: 10.1016/j.radcr.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Boerhaave's syndrome is a potentially fatal emergency, typically induced by forceful retching, which leads to increased intra-esophageal pressure. It commonly presents with vague symptoms such as chest pain or more classic symptoms like subcutaneous emphysema and vomiting. We present an unusual case of Boerhaave syndrome secondary to rapid and excessive intake of carbonated drinks in a 22-year-old male, who presented to our emergency department with atypical symptoms of fever and shortness of breath. Imaging studies showed left-sided hydropneumothorax with an esophageal pleural fistula, and multidisciplinary teams were involved in the patient's management.
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Affiliation(s)
- Fatima Bhojani
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Gulnaz Shafqat
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Uffan Zafar
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Anam Khan
- Department of Radiology, Aga Khan University, Karachi, Pakistan
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2
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Aldoseri R, Nasser M, Alshehabi M. A Case of an Atypical Presentation of Spontaneous Esophageal Rupture. Cureus 2024; 16:e57578. [PMID: 38586228 PMCID: PMC10995756 DOI: 10.7759/cureus.57578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
Spontaneous esophageal rupture is an uncommon medical phenomenon that involves a sudden increase in intraesophageal pressure with negative intrathoracic pressure. Here, a 21-year-old female with no history of medical illness was admitted to our accident and emergency department with a one-day history of sudden retrosternal chest pain with other symptoms. There was no foreign body ingestion, vomiting, fever, cough, trauma, or recent procedures. Physical examination revealed a soft abdomen with epigastric tenderness and normal respiratory and cardiovascular examinations. The patient underwent a chest X-ray and a computed tomography scan of the neck and chest, which revealed retropharyngeal air extending to the mediastinum with anterior chest surgical emphysema. Oesophago-gastro-duodenoscopy revealed mild gastritis with no evidence of foreign body or esophagus injury. The patient was prescribed paracetamol, pantoprazole, and clindamycin. On follow-up, the patient was doing well with no active complaints. Conservative management of spontaneous esophageal rupture can result in good clinical outcomes with no requirement for additional interventions.
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Affiliation(s)
- Rashed Aldoseri
- Otolaryngology - Head and Neck Surgery, Royal Medical Services, Riffa, BHR
| | - Mai Nasser
- Otolaryngology - Head and Neck Surgery, Royal Medical Services, Riffa, BHR
| | - Mohamed Alshehabi
- Otolaryngology - Head and Neck Surgery, Royal Medical Services, Riffa, BHR
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3
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Sundbom M. Advances in minimal invasive treatment for esophageal perforation. J Thorac Dis 2023; 15:3550-3553. [PMID: 37559618 PMCID: PMC10407501 DOI: 10.21037/jtd-23-478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/02/2023] [Indexed: 08/11/2023]
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4
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Loftus IA, Umana EE, Scholtz IP, McElwee D. Mackler's Triad: An Evolving Case of Boerhaave Syndrome in the Emergency Department. Cureus 2023; 15:e37978. [PMID: 37223188 PMCID: PMC10202041 DOI: 10.7759/cureus.37978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
An elderly lady, known with a background history of Alzheimer's dementia, gastro-oesophageal reflux disease and a reported history of self-induced vomiting, presented to our emergency department with a two-day history of vomiting, diarrhoea, anorexia, and malaise. Initial clinical examination and investigations only demonstrated mild dehydration. Despite a satisfactory response to initial symptomatic treatment, with complete cessation of vomiting, the patient had a recent sudden deterioration. Due to continued forcible belching, it was found that she had developed a sudden onset of back pain and subcutaneous emphysema. A CT scan showed mid-oesophageal rupture along with pneumomediastinum and bilateral pneumothoraxes. The patient was subsequently diagnosed with Boerhaave syndrome. Due to her clinical factors and the risk of surgical management, it was decided that she should be managed non-operatively with oesophageal stenting and bilateral chest drains, which was met with a good clinical course and outcome.
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Affiliation(s)
- Izak A Loftus
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IRL
| | - Etimbuk E Umana
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IRL
| | - Izak P Scholtz
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IRL
| | - Deirdre McElwee
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, IRL
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Tan N, Luo YH, Li GC, Chen YL, Tan W, Xiang YH, Ge L, Yao D, Zhang MH. Presentation of Boerhaave's syndrome as an upper-esophageal perforation associated with a right-sided pleural effusion: A case report. World J Clin Cases 2022; 10:6192-6197. [PMID: 35949820 PMCID: PMC9254195 DOI: 10.12998/wjcc.v10.i18.6192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/18/2022] [Accepted: 04/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spontaneous esophageal rupture or Boerhaave's syndrome is a rare and acute disease with a high incidence of misdiagnosis and mortality. Here, we aimed to explore the clinical characteristics, diagnosis, treatment, and prognosis of spontaneous esophageal rupture, and to analyze the causes of misdiagnosis during the treatment of spontaneous esophageal rupture. CASE SUMMARY The clinical features of the patient with spontaneous esophageal rupture misdiagnosed earlier as pleural effusion were retrospectively analyzed and the reasons for misdiagnosis are discussed based on a current review of the literature. The patient was admitted to a local hospital due to shortness of breath accompanied by vomiting and abdominal distension for five hours. Based on the computed tomography (CT) scan analysis, clinically, right pleural effusion was diagnosed. However, the patient was unwilling to undergo right closed thoracic drainage. The patient also had intermittent fevers against infection, and during the course of treatment, he complained of chest pain, following which, he was transferred to our hospital. Grapefruit-like residue drainage fluid was observed. Re-examination of the chest CT scans suggested the presence of spontaneous perforation in the upper left esophagus. Therefore, the patient underwent an urgent esophageal hiatus repair. Unfortunately, the patient died of infection and respiratory failure due to progressive dyspnea after surgery. CONCLUSION Spontaneous esophageal rupture is a rare disease associated with high fatality. The patients do not present typical clinical symptoms and the disease progresses rapidly. This case report highlights the importance of a dynamic review of chest CT scan, not only for the initial identification of segmental injury but also for prioritizing subsequent treatment strategies. Moreover, we have presented some clues for clinicians to recognize and diagnose spontaneous esophageal rupture at rare sites (upper-esophageal segment) through this case report of spontaneous esophageal rupture that caused the patient's death. We have also summarized the reasons for the misdiagnosis and lessons learned.
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Affiliation(s)
- Ni Tan
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Yin-Hua Luo
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Guang-Cai Li
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Yi-Lin Chen
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Wei Tan
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Yue-Hua Xiang
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Liang Ge
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Di Yao
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
| | - Ming-Hua Zhang
- Pulmonary and Critical Care Medicine, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Autonomous Prefecture 445000, Hubei Province, China
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Ceriz T, Diegues A, Lagarteira J, Terras Alexandre R, Carrascal A. Boerhaave’s Syndrome: A Case Report. Cureus 2022; 14:e23836. [PMID: 35530901 PMCID: PMC9072258 DOI: 10.7759/cureus.23836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Boerhaave’s syndrome is a rare spontaneous perforation of the esophagus with high mortality. The diagnosis is difficult because it has no specific symptom. It requires urgent intervention. We report the case of a 63-year-old male admitted to the emergency department with respiratory distress. Chest computed tomography (CT) revealed large, bilateral, and tension hydropneumothorax, stomach distention, and aerobilia. Thoracic drainage was performed immediately. Control CT revealed esophagus perforation in the middle third of the esophagus with extravasation of the contrast product from the esophagus to the pleura. Urgent surgery was performed, and the patient was admitted to the intensive care unit (ICU) with septic shock. Early diagnosis and management with a damage control approach including thoracic drainage and surgery are essential to improve prognosis and reduce mortality.
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Enhanced Recovery Protocol for Boerhaave Syndrome: Our Experience. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Awofisoye OI, Olalekan OE, Anumenechi N, Onwukpa F. Boerhaave's syndrome after pentazocine-induced vomiting in a 21-year-old male with asthma: a case report. Pan Afr Med J 2021; 38:74. [PMID: 33889240 PMCID: PMC8033192 DOI: 10.11604/pamj.2021.38.74.27031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/13/2021] [Indexed: 11/11/2022] Open
Abstract
Boerhaave's syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave's is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. We report the case of 21-year-old male with who developed sudden onset chest pain and dyspnoea after pentazocine induced vomiting. He was referred after lack of response to initial treatment for acute severe asthma. A chest CT scan showed pneumomediastinum, subcutaneous emphysema and oesophageal tear. He was managed conservatively with oxygen therapy, nil per mouth and antibiotics with improvement of symptoms and discharge after 8 days.
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Abstract
Emergency departments (EDs) are the primary driver for hospital admissions in the United States (US), and that trend is likely to continue through the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. As the US continues to experience rampant community spread, coronavirus disease 2019 (COVID-19) will likely present in increasingly variable ways to the EDs. We present a case of Mallory-Weiss tear and esophageal perforation, which was likely caused by COVID-19 pneumonia. This case is notably the first of its kind that we have seen reported in the COVID-19-related literature. Clinicians should be vigilant about the various complications of COVID-19 and continue to exercise caution when seeing and treating these patients.
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Affiliation(s)
- Patrick Meloy
- Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| | - Amit Bhambri
- Emergency Medicine, Swedish Hospital - Part of NorthShore University HealthSystem, Chicago, USA
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Catarino Santos S, Barbosa B, Sá M, Constantino J, Casimiro C. Boerhaave's syndrome: A case report of damage control approach. Int J Surg Case Rep 2019; 58:104-107. [PMID: 31029781 PMCID: PMC6487369 DOI: 10.1016/j.ijscr.2019.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Boerhaave's syndrome is a life-threatening oesophageal perforation that carries a high mortality rate (20-50%). Diagnosis is difficult by its rarity and the absence of typical symptoms. Treatment of this condition usually requires surgical intervention. PRESENTATION OF CASE We report the case of a 77-year-old man that resorted to the emergency room with dyspnoea and thoracic pain after vomiting. CT scan revealed pneumomediastinum, left collapse lung and loculated pleural effusion. A left intercostal chest tube was inserted with food drainage. Hence, Boerhaave's syndrome was suspected. Thoracotomy with mediastinum debridement, pleural drainage and oesophageal T-tube drainage was performed. Patient was admitted on the Intensive Care Unit with septic shock, with need for ventilatory support and vasopressor therapy. Two days later, a second look thoracotomy was done with definitive oesophageal repair and pleural patch. The post-operative course was complicated by pneumonia and stroke. Patient was discharged home on the 38th day and remains well at 3 month of follow-up. DISCUSSION Delayed diagnosis and treatment are the principal causes of high mortality in Boerhaave's syndrome. The classic Mackler's triad (vomiting, lower thoracic pain and subcutaneous emphysema) is present in less then 50% of cases. A thoracic drainage may be useful to confirm diagnosis promptly. There is no standard treatment option. In this case report, the authors used a damage control approach to control sepsis, allowing for a delayed definitive oesophageal repair. CONCLUSION Prompt diagnosis with thoracic drainage and a damage control treatment plan might lead to good prognosis for patients with this rare and potentially fatal condition.
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Affiliation(s)
- Sara Catarino Santos
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Bruno Barbosa
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Milene Sá
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Júlio Constantino
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
| | - Carlos Casimiro
- Serviço de Cirurgia Geral do Centro Hospitalar Tondela-Viseu, Avenida Rei D. Duarte, 3504-509, Viseu, Portugal.
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Baird J, Norinsky AB. When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage. World J Emerg Med 2016; 7:303-306. [PMID: 27965726 DOI: 10.5847/wjem.j.1920-8642.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- James Baird
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, New Jersey, USA
| | - Alexander B Norinsky
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, New Jersey, USA
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Davies J, Spitzer D, Phylactou M, Glasser M. Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome. BMJ Case Rep 2016; 2016:bcr-2014-208659. [PMID: 27154984 DOI: 10.1136/bcr-2014-208659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces. A diagnosis of Boerhaave's syndrome was made. The patient was transferred to the intensive care unit but did not survive. This case demonstrates the importance of looking for and treating the rarer reversible causes of cardiac arrest, and of maintaining a high index of suspicion for Boerhaave's syndrome. Despite its rarity, Boerhaave's syndrome is often misdiagnosed on initial presentation, leading to delayed treatment and poor outcomes.
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Affiliation(s)
| | | | - Maria Phylactou
- Department of Endocrinology, Hillingdon Hospital, Uxbridge, Middlesex, UK
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Sundbom M, Hedberg J. Successful stenting of four spontaneous oesophageal perforations in a single patient during a 3-year period. J Surg Case Rep 2016; 2016:rjw046. [PMID: 27154748 PMCID: PMC4915075 DOI: 10.1093/jscr/rjw046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Spontaneous oesophageal perforation, a rare condition associated with high mortality due to mediastinitis and multi-organ failure, can be treated surgically or with endoscopic stents. We present a case of four right-sided oesophageal perforations during a 3-year period in a single patient, all successfully stented. The 51-year-old Caucasian male had his first oesophageal perforation in 2012, which was successfully treated with a fully covered endoscopic stent. No residual pathology was seen at stent removal. Two years later, the patient was successfully treated with stents twice for recurrent perforations. The fourth spontaneous perforation at the same site occurred this fall, and again endoscopic treatment was successful. The patient does not report any squeals. In spite of the successful outcome, we would like to emphasize the need for close surveillance and readiness for definitive surgical treatment.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden
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Adhikari DR, Tiwari AR, Vankipuram S, Chaphekar AP, Satardey R. A Successful Strategy for Surgical Treatment of Boerhaave's Syndrome Sans Thoracotomy. J Clin Diagn Res 2015; 9:PD05-6. [PMID: 26393167 DOI: 10.7860/jcdr/2015/13517.6263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/23/2015] [Indexed: 12/18/2022]
Abstract
Boerhaave's syndrome is a rare life threatening condition that is often misdiagnosed and fatal if not treated promptly. While the gold standard is early surgical intervention, recent studies have showed success with conservative management. We report a case of Boerhaave's syndrome that was managed conservatively by decompressive gastrostomy, feeding jejunostomy, bilateral intercostal drainage tubes with added proximal diverting cervical esophagostomy. The patient recovered completely and stoma closure was done two months later.
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Affiliation(s)
- Devbrata Radhikamohan Adhikari
- Assistant Professor, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Charitable Nair Hospital , Mumbai Central, India
| | - Ajeet Ramamani Tiwari
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Charitable Nair Hospital , Mumbai Central, India
| | - Siddharth Vankipuram
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Charitable Nair Hospital , Mumbai Central, India
| | - Aniruddha Prabhakar Chaphekar
- Associate Professor, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Charitable Nair Hospital , Mumbai Central, India
| | - Ritesh Satardey
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Charitable Nair Hospital , Mumbai Central, India
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