Original communicationAnatomy of the Boerhaave syndrome
Section snippets
Experimental model
We used an experimental model used already by other authors, in which the rupture of the esophagus is achieved by means of the insufflation of air into the esophageal lumen.4, 6 The experiments were carried out in 6 fresh human cadavers, 3 men and 3 women, with a mean age of 43 years (range, 10-66 years), mean height of 1.62 m (range, 1.32-1.80 m), and a mean weight of 67 kg (range, 38-90 kg). The specimens used were in perfect condition without the existence of hiatal hernia or disease or
Results
In the 6 experimental specimens, the esophageal rupture occurred in the lower third of the esophagus immediately above the diaphragmatic hiatus, and in all cases the tears were longitudinal (Fig 1). The phrenoesophageal membrane was not involved. In 5 esophagi, the lesion was oriented to the left side in 4 and to the right side in 1. In 5 esophagi, the rupture occurred as a single lesion, while one esophagus suffered 2 longitudinal wounds separated by a narrow bridge of esophageal wall.
The
Discussion
According to clinical and experimental data, in the spontaneous rupture of the esophagus, or Boerhaave syndrome, it is possible to recognize some characteristic findings.1, 2, 4 The rupture is usually the result of a sudden increase in intraesophageal pressure.3, 4, 6, 7, 8, 9, 10 The rupture is usually longitudinal, from 2 to 6 cm long, and located at the left side of the lower third of the esophagus.2, 3, 11, 12, 13 Rupture of the cervical,14 middle third,15, 16 or abdominal segment of the
References (20)
- et al.
Muscular equivalent of the lower esophageal sphincter
Gastroenterology
(1979) - et al.
Hermann Boerhaave’s Atrocis, nec descripti prius morbid historiaThe first translation of the classic case report of rupture of the esophagus with annotations
Bull Med Libr Assoc
(1955) - et al.
Boerhaave’s syndrome: analysis of the literature and report of 18 new cases
Dis Esophagus
(1997) - et al.
Oesophageal injury: part 2The changing face of the management of ruptured oesophagus: Boerhaave’s syndrome
Gullet
(1990) Spontaneous rupture of the esophagus: an experimental and clinical study
Surg Gynecol Obstet
(1952)- et al.
Spontaneous rupture of the esophagus
Ann Int Med
(1954) - et al.
Spontaneous rupture of the esophagus
J R Coll Surg Edin
(1974) Rupture of oesophagus during childbirth
Br Med J
(1950)- et al.
Rupture of the esophagus
Med Bull Vet Admin
(1943) Spontaneous rupture of the esophagus
Pennsylvania Med J
(1932)
Cited by (62)
Recent advance using minimally thoracoscopy for the management of Boerhaave syndrome
2023, Surgery Open Digestive AdvanceA rare case of Boerhaave syndrome with cervico-thoracic esophageal junction rupture causing bilateral empyema; case report from Nepal
2023, International Journal of Surgery Case ReportsManagement of upper gastrointestinal perforations
2022, Surgery (United Kingdom)Citation Excerpt :Anatomically, this usually affects the left posterolateral aspect of the distal oesophagus, owing to a lack of supporting mediastinal structures here. The tear is often located between the clasp and oblique fibres, extending upwards.3 Due to their size, rigidity, and pointed edges, dentures frequently impact in the oesophagus but ingestion of any foreign body of size with sharp edges can result in perforation.
Cognitive Aids for the Management of Thoracic Anesthesia Emergencies: Consensus Guidelines on Behalf of a Canadian Thoracic Taskforce
2022, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Esophageal rupture specifically results from an abrupt increase in esophageal pressure, as occurs with severe vomiting; this is known as Boerhaave's syndrome and accounts for 15% of esophageal disruptions.60 This usually involves a large tear located on the left border of the lower third of the thoracic esophagus.60,61 Esophageal rupture will cause significant contamination of the mediastinum and pleural cavity with gastric contents, leading to acute mediastinitis and sepsis.
An autopsy case of spontaneous esophageal perforation (Boerhaave syndrome)
2016, Legal MedicineCitation Excerpt :Vomiting could be one of the causes of intraesophageal pressure increase, since vomiting seems to be the antecedent episode in most cases [1,10,12–18]. The rupture or perforation occurs mostly on the left lateral part of the inferior third of the esophagus, measuring about 15–35 mm (mean 22 mm) [9–15,19]. It is reported that there is a male predominance of 2:1–5:1.