Boerhaave syndrome is a rare spontaneous rupture to the esophagus. Esophagus most commonly results from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure caused by straining or vomiting.
In most cases of Boerhaave's syndrome, the tear occurs at the left posterolateral aspect of the distal esophagus and extends for several centimeters. The condition is associated with high morbidity and is fatal in the absence of therapy. The occasionally nonspecific nature of the symptoms may contribute to a delay in diagnosis and a poor outcome.
The syndrome is commonly related with the consumption of excessive food and/or alcohol. The most common anatomical location of the tear in Boerhaave syndrome is at left posterolateral wall of the base third of the esophagus, 2-3 cm before the stomach Boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from Mallory-Weiss syndrome, a nontransmural esophageal tear also associated with vomiting. Symptoms of Boerhaave syndrome include vomiting with sudden pain in thorax and epigastrium which may radiate to the neck, progressive dyspnea, tachypnea, cyanosis and shock.
Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock develop rapidly thereafter. It can cause pneumomediastinum and/or mediastinitis and sepsis. Treatment of boerhaave's syndrome includes immediate antibiotic therapy to prevent mediastinitis and sepsis, surgical repair of the perforation and if there is significant fluid loss it should be replaced with IV fluid therapy since oral rehydration is, obviously, not possible. Broad spectrum intravenous antibiotics to treat or prevent mediastinitis. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
