Boerhaave syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Ajay Gade MD[3]], Feham Tariq, MD [4]
Overview
The clinical manifestations of Boerhaave syndrome (BHS) depend on the location of the perforation. Boerhaave syndrome often presents with excruciating retrosternal chest pain due to an intrathoracic esophageal perforation. Boerhaave syndrome is classically associated with a history of severe retching and vomiting. However, 25 to 45 percent of patients have no history of vomiting.
History and Symptoms
The history and symptoms are as follows:[1][2][3][4][5]
History
- Obtaining history gives important information in making a diagnosis of BHS.
- It provides insight into the cause, precipitating factors, and associated comorbid conditions.
- A complete history will help determine the correct therapy and determining the prognosis.
- The areas of focus should be on onset, duration, and progression of symptoms such as
Symptoms
- The clinical manifestations of Boerhaave syndrome depend on the:
- Location of the perforation (cervical, intrathoracic, or intra-abdominal),
- The time since the injury
- The degree of leakage
- Boerhaave syndrome often presents with excruciating retrosternal chest pain due to an intrathoracic esophageal perforation.
- Boerhaave syndrome is classically associated with a history of severe retching and vomiting, however, 25 to 45 percent of patients have no history of vomiting.
- Soon after the perforation, patients can have:
- Odynophagia
- Dyspnea
- Fever
- Tachypnea
- Tachycardia
- Cyanosis, and hypotension on physical examination.
- A pleural effusion may also occur.
- Patients with cervical perforations can present with:
- Patients with an intra-abdominal perforation have epigastric pain that may radiate to the shoulder causing physicians to confuse an esophageal perforation with a myocardial infarction.
- These patients may also have back pain or present with an acute abdomen.
- Mackler's triad is only present in 14% of patients which includes:
- It may also be audibly recognized as Hamman's sign.
- Hamman's sign is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium in spontaneous mediastinal emphysema produced by the heart beating against air-filled tissues.
References
- ↑ McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
- ↑ Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
- ↑ Woo KM, Schneider JI (2009). "High-risk chief complaints I: chest pain--the big three". Emerg. Med. Clin. North Am. 27 (4): 685–712, x. doi:10.1016/j.emc.2009.07.007. PMID 19932401. Unknown parameter
|month=ignored (help) - ↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
- ↑ Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR (1997). "Boerhaave's syndrome: analysis of the literature and report of 18 new cases". Dis. Esophagus. 10 (1): 64–8. PMID 9079278.