View source for Boerhaave syndrome

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{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = Boerhaaves-syndrome-002.jpg|
  Caption        = |
  DiseasesDB     = 9168 |
  ICD10          = {{ICD10|K|22|3|k|20}} |
  ICD9           = {{ICD9|530.4}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  MeshID         = D004939 |
}}
{{Boerhaave syndrome}}

'''For patient information, click [[Boerhaave syndrome (patient information)|here]]'''

'''Editor in Chief''': Liudvikas Jagminas, MD, FACEP [mailto:LJagminas@mhri.org] Phone: 401-729-2419

{{SK}}: Oesophageal rupture, esophageal perforation, esophageal rupture


==Overview==

'''Boerhaave syndrome''' (also called '''Boerhaave's syndrome'''), or '''Esophageal perforation''', is rupture of the [[esophagus|esophageal]] wall. It is most often caused by excessive [[vomiting]] in [[eating disorders]] such as [[bulimia]] although it may rarely occur in extremely forceful [[cough]]ing or other situations, such as [[Esophageal food bolus obstruction|obstruction by food]]. It can cause [[pneumomediastinum]] and/or [[mediastinitis]] (air or inflammation of the [[mediastinum]]) and [[sepsis]]. 

This condition was first documented by the 18th-century physician [[Herman Boerhaave]], after whom it is named.<ref>{{WhoNamedIt|synd|2800}}</ref><ref>H. Boerhaave. Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta. Lugduni Batavorum; Ex officine Boutesteniana. 1724. </ref>

==Symptoms==
It typically occurs after forceful [[vomiting]]. Boerhaave syndrome is a transmural perforation (full-thickness; a '''hole''') of the [[esophagus]], distinct from [[Mallory-Weiss syndrome]], a nontransmural esophageal '''tear''' also associated with vomiting.

Because it is generally associated with vomiting, Boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from [[iatrogenic]] perforation, which accounts for 85-90% of cases of esophageal rupture, typically as a complication of an [[endoscopic]] procedure, feeding tube, or unrelated [[surgery]]. Boerhaave syndrome is often seen as a complication of Bulimia.

It is associated with "Meckler's triad".<ref>S. Herman, H. Shanies, H. Singh & M. Warshawsky: "Spontaneous Esophageal Rupture: Boerhaave's Syndrome," pages 177-182. Clinical Pulmonary Medicine 10(3), May 2003 [http://www.clinpulm.com/pt/re/clnpulmed/abstract.00045413-200305000-00007.htm abstract]</ref><ref name="pmid12854388">{{cite journal |author=Yang ST, Devanand A, Tan KL, Eng PC |title=Boerhaave's syndrome presenting as a right-sided pleural effusion |journal=Ann. Acad. Med. Singap. |volume=32 |issue=3 |pages=415–7 |year=2003 |pmid=12854388 |doi=}}</ref>

==Pathophysiology==
Esophageal rupture in Boerhaave syndrome is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle (a [[sphincter]] within the esophagus) to relax. The syndrome is commonly associated 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 lower third of the esophagus, 2-3 cm before the [[stomach]].<ref name="pmid17263979">{{cite journal |author=Korn O, Oñate JC, López R |title=Anatomy of the Boerhaave syndrome |journal=Surgery |volume=141 |issue=2 |pages=222–8 |year=2007 |pmid=17263979 |doi=10.1016/j.surg.2006.06.034}}</ref>

==Diagnosis==

Images shown below are courtesy of RadsWiki

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==Treatment==
Its treatment includes immediate [[antibiotic|antibiotic therapy]] to prevent [[mediastinitis]] and sepsis, surgical repair of the perforation,<ref name="pmid17220586">{{cite journal |author=Matsuda A, Miyashita M, Sasajima K, ''et al'' |title=Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report |journal=Journal of Nippon Medical School &#61; Nihon Ika Daigaku zasshi |volume=73 |issue=6 |pages=341–5 |year=2006 |pmid=17220586 |doi=}}</ref> and if there is significant fluid loss it should be replaced with [[Intravenous therapy|IV fluid therapy]] since oral rehydration is, obviously, not possible.

==References==
{{Reflist|2}}

==References==
* [http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine]
* [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine]


{{Gastroenterology}}
[[Category:Surgery]]
[[Category:Gastroenterology]]
[[Category:Needs patient information]]

[[de:Boerhaave-Syndrom]]
[[pt:Síndrome de Boerhaave]]
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