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{{Infobox_Disease |
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  Name          = {{PAGENAME}} |
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  Image          = Boerhaaves-syndrome-002.jpg|
|[[File:Siren.gif|link=Esophageal rupture resident survival guide|41x41px]]|| <br> || <br>
  Caption        = |
| [[Esophageal rupture resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  DiseasesDB    = 9168 |
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  ICD10          = {{ICD10|K|22|3|k|20}} |
  ICD9          = {{ICD9|530.4}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  MeshID        = D004939 |
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{{Boerhaave syndrome}}
{{Boerhaave syndrome}}


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


{{CMG}} {{AE}} {{DM}}, {{Ajay}}, {{FT}}, {{SHH}}


'''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 overview|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]].
==[[Boerhaave syndrome historical perspective|Historical Perspective]]==


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>
==[[Boerhaave syndrome classification|Classification]]==


==Symptoms==
==[[Boerhaave syndrome pathophysiology|Pathophysiology]]==
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.
==[[Boerhaave syndrome causes|Causes]]==


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>
==[[Boerhaave syndrome differential diagnosis|Differentiating Boerhaave syndrome from other Disorders]]==


==Pathophysiology==
==[[Boerhaave syndrome epidemiology and demographics|Epidemiology and Demographics]]==
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>
==[[Boerhaave syndrome risk factors|Risk Factors]]==


==Diagnosis==
==[[Boerhaave syndrome screening|Screening]]==


Images shown below are courtesy of RadsWiki
==[[Boerhaave syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


<div align="left">
==Diagnosis==
<gallery heights="175" widths="175">
[[Boerhaave syndrome history and symptoms|History and Symptoms]] | [[Boerhaave syndrome physical examination|Physical Examination]] | [[Boerhaave syndrome laboratory findings|Laboratory Findings]] | [[Boerhaave syndrome electrocardiogram|Electrocardiogram]] | [[Boerhaave syndrome chest x ray|Chest X Ray]] | [[Boerhaave syndrome CT|CT]] | [[Boerhaave syndrome MRI|MRI]] | [[Boerhaave syndrome other diagnostic studies|Other Diagnostic Studies]]
Image:Boerhaaves-syndrome-001.jpg
Image:Boerhaaves-syndrome-002.jpg
Image:Boerhaaves-syndrome-003.jpg
</gallery>
</div>


==Treatment==
==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.
[[Boerhaave syndrome medical therapy|Medical Therapy]] | [[Boerhaave syndrome surgery|Surgery]] | [[Boerhaave syndrome primary prevention|Primary Prevention]]  | [[Boerhaave syndrome secondary prevention|Secondary Prevention]] | [[Boerhaave syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Boerhaave syndrome future or investigational therapies|Future or Investigational Therapies]]
 
==References==
{{Reflist|2}}


==References==
==Case Studies==
* [http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine]
[[Boerhaave syndrome case study one|Case #1]]
* [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine]




Latest revision as of 21:30, 6 February 2018
Resident
Survival
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Overview

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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], Shaghayegh Habibi, M.D.[5]

Synonyms and keywords: Oesophageal rupture, esophageal perforation, esophageal rupture

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Boerhaave syndrome from other Disorders

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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