Boerhaave syndrome history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History and Symptoms
The clinical manifestations of Boerhaave syndrome depend on the location of the perforation (cervical, intrathoracic, or intra-abdominal), the time since the injury occurred, the degree of leakage.
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.[1]
Soon after the perforation, patients can have odynophagia, dyspnea, fever, tachypnea, tachycardia, cyanosis, and hypotension on physical examination. A pleural effusion may also occur.[2]
The classic history of esophageal rupture is one of severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock develop rapidly thereafter.
The following features were described in an illustrative review:[citation needed]
- A history of alcoholism or heavy drinking was present in 40 percent; presentation during an episode of alcoholism may contribute to a delay in diagnosis.
- A history of gastroduodenal ulcer disease was present in 41 percent.
- Pain occurred in 83 percent, vomiting in 79 percent, dyspnea in 39 percent, and shock in 32 percent.
Mackler's triad which includes chest pain, vomiting and subcutaneous emphysema, while classical, is only present in 14% of people.[3]
Pain can occasionally radiate to the left shoulder, causing physicians to confuse an esophageal perforation with a myocardial infarction.
It may also be audibly recognized as Hamman's sign.
References
- ↑ Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
- ↑ McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
- ↑ 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
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