A lesson in clinical findings, diagnosis, reassessment and outcome: Boerhaave's syndrome

BMJ Case Rep. 2012 Jun 21:2012:bcr2012006485. doi: 10.1136/bcr-2012-006485.

Abstract

A man in his 30s presented with a brief episode of vomiting, acute abdominal pain and subsequent development of shortness of breath. On initial examination and investigation, the clinical impression was of a right-sided pneumothorax, pneumonia and pleural effusion. Early antibiotic treatment and management showed a clinical improvement, with the patient reporting resolution of his symptoms. This episode was short lived, with a further deterioration in his condition and worsening of symptoms. Ensuing examination, imaging and investigations demonstrated an oesophageal leak into the right pleural cavity. Following urgent stabilisation measures and insertion of a chest drain, he underwent successful surgical repair. Boerhaave's syndrome is an emergency situation, requiring quick recognition, diagnosis, aggressive treatment and management to optimise a good outcome.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / etiology
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Delayed Diagnosis
  • Dyspnea / etiology
  • Esophageal Perforation / complications
  • Esophageal Perforation / diagnosis*
  • Esophageal Perforation / surgery*
  • Humans
  • Male
  • Mediastinal Diseases / complications
  • Mediastinal Diseases / diagnosis*
  • Mediastinal Diseases / surgery*
  • Pneumonia / complications
  • Tomography, X-Ray Computed
  • Treatment Refusal
  • Vomiting / etiology

Substances

  • Anti-Bacterial Agents

Supplementary concepts

  • Boerhaave syndrome