Author:
Haba Yuichiro,Yano Shungo,Akizuki Hikaru,Hashimoto Takashi,Naito Toshio,Hashiguchi Naoyuki
Abstract
Abstract
Background
Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room.
Case presentation
The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome.
Conclusion
Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.
Publisher
Springer Science and Business Media LLC
Reference18 articles.
1. Boerhaave H. Atrocis, nec descripti prius, morbid historia sccundum medicac artis leges conscripta, lugduni batavorum, boutesteniana. Medici. 1724; 60. Translated in Bull Med Libr Assos. 1955;43:217–40.
2. Turner AR, Turner SD. Boerhaave syndrome. StatPearls Publ. 2020. https://www.ncbi.nlm.nih.gov/books/NBK430808/. Accessed 25 July 2020.
3. Schipper P, Gunne AFP, Oostvogel HJM, Laarhoven CJHM. Spontaneous rupture of the oesophagus: Boerhaave’s syndrome in 2008. Literature review and treatment algorithm. Dig Surg. 2009;26:1–6.
4. Mackler SA. Spontaneous rupture of the esophagus. An experimental and clinical study. Surg Gynecol Obestet. 1952;95:345–56.
5. Henderson JAM, Peloquin AJM. Boerhaave revisited: spontaneous esophageal perforation as a diagnostic masquerader. Am J Med. 1989;86:559–67.
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献