Boerhaave syndrome overview: Difference between revisions
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===Imaging Findings=== | ===Imaging Findings=== | ||
Erect radiograph chest posteroanterior view is the most useful in early diagnosis. In most patients with Boerhaave syndrome chest x-ray shows one-sided effusion, [[pneumothorax]], [[hydropneumothorax]], [[pneumomediastinum]] and [[subcutaneous emphysema]]. | |||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
Revision as of 19:17, 6 February 2018
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Boerhaave syndrome overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Feham Tariq, MD [2]
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Overview
Boerhaave syndrome or Esophageal perforation, is rupture of the esophageal wall. It is an emergency, life-threatening condition. It is most often caused by excessive vomiting in eating disorders such as bulimia although it may rarely occur in extremely forceful coughing or other situations, such as obstruction by food. It can cause pneumomediastinum and/or mediastinitis (air or inflammation of the mediastinum) and sepsis.
Historical Perspective
Boerhaave syndrome was first described in 1724 by the physician Herman Boerhaave, after whom it is named.
Classification
Boerhaave syndrome may be classified according to the location of involvement into three groups of distal intrathoracic, intra-abdominal and cervical esophageal perforation. It also may be classified according to the time of presentations into three groups of acute, subacute and chronic perforation.
Pathophysiology
Boerhaave syndrome is a spontaneous longitudinal perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. It is commonly associated with the consumption of excessive food and/or alcohol.
Causes
Boerhaave syndrome (BHS) causes include seizures, severe straining, vomiting, child birth, Iatrogenic, prolonged coughing or laughing.
Differentiating Boerhaave syndrome overview from Other Diseases
Boerhaave syndrome must be differentiated from other diseases that cause abdominal pain such as Mallory-Weiss syndrome, myocardial infarction, pancreatitis, and peptic ulcer disease.
Epidemiology and Demographics
The incidence of Boerhaave syndrome is 3.1 per 100,000 individuals. Boerhaave syndrome accounts for 15% of all cases of spontaneous perforations of the esophagus. Boerhaave syndrome is most frequently seen among patients 50-70 years of age, and least susceptible to age group is 1-17 years. Boerhaave syndrome is slightly more common in males.
Risk Factors
Boerhaave syndrome (BHS) usually occurs in patients with a normal underlying esophagus. The most potent risk factor in the development of Boerhaave syndrome is overindulgence in food and alcohol, Iatrogenic. Other risk factors include Eosinophilic esophagitis, medication-induced esophagitis, and Infectious ulcers.
Screening
There is insufficient evidence to recommend routine screening for Boerhaave syndrome.
Natural History, Complications, and Prognosis
If Boerhaave syndrome (BHS) left untreated, the mortality reaches 100%, without adequate treatment, survival of Boerhaave's syndrome is in days. Most common complications of Boerhaave syndrome include pneumomediastinum, Mediastinitis, Sepsis, Posterior mediastinal abscess. Boerhaave's syndrome has a high mortality rate (14-40%).
Diagnosis
History and Symptoms
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 classically associated with a history of severe retching and vomiting, however, 25 to 45 percent of patients have no history of vomiting.
Physical Examination
The patient might be in moderate distress with epigastric pain and bleeding. Patients may experience Tachycardia, weak pulse, hypotension, Diaphoresis and fever.
Laboratory Findings
Laboratory findings often are nonspecific. Patients may present with leukocytosis. As many as 50% of patients with Boerhaave syndrome have a hematocrit value of 50% due to fluid loss into pleural spaces and tissues.
Imaging Findings
Erect radiograph chest posteroanterior view is the most useful in early diagnosis. In most patients with Boerhaave syndrome chest x-ray shows one-sided effusion, pneumothorax, hydropneumothorax, pneumomediastinum and subcutaneous emphysema.
Other Diagnostic Studies
Treatment
Medical Therapy
Conservative management of Boerhaave syndrome consists of: intravenous fluids should be instituted, antibiotics, nasogastric suction, keeping the patient NPO, adequate drainage with tube thoracostomy or formal thoracotomy.