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]
- Patients with cervical perforations can present with neck pain, dysphagia or dysphonia.
- 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. They may also have back pain or present with an acute abdomen.
Mackler's triad (chest pain, vomiting and subcutaneous emphysema) is only present in 14% of patients.[3]
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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