Boerhaave syndrome overview

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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.

This condition was first documented by the 18th-century physician Herman Boerhaave, after whom it is named.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Boerhaave syndrome overview from Other Diseases

Epidemiology and Demographics

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

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

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

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.

Surgery

Prevention

References