Year 2017 / Volume 109 / Number 1
Digestive Diseases Image
Boerhaave’s syndrome: diagnostic gastroscopy

65-66

Rocío Ferreiro-Iglesias, Manuel Narciso Blanco Freire, Manuel Paz Novo, J. Enrique Domínguez Muñoz,

Abstract
A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with esophageal rupture or Boerhaave’s syndrome in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction. Thoracic-abdominal computed tomography (TC) confirmed a perforation of the lower esophagus, with pneumothorax and cervical and chest emphysema. Surgical treatment was indicated: esophageal suture, myotomy and gastric fundoplication. The patient presented good evolution. Boerhaave’s syndrome is a rare syndrome, but with high mortality (35%). Mackler triad is very characteristic: vomiting, retrosternal pain and cervical subcutaneous emphysema; but it occurs rarely. Chest radiography is useful, showing abnormalities in up to 90% of patients. The differential diagnosis includes cardiorespiratory disorders: acute myocardial infarction, spontaneous pneumothorax, pericarditis or pneumonia. The role of endoscopy is small, mainly limited to prosthesis placement in high-risk surgical patients. In our case the chest radiograph was initially normal, probably related to bolus impaction and, in presence of upper gastrointestinal bleeding, gastroscopy was performed which allowed us to early diagnosis and treatment.
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References
Salvador Baudet J, Arencibia A, Soler M, et al. Spontaneous esophageal rupture (Boerhaave’s syndrome. Rev Esp Enferm Dig 2011; 103: 482-3.
Vallböhmer D, Hölscher AH, Hölscher M, et al. Options in the management of esophageal perforation: analysis over a 12-year period. Dis Esophagus 2010;23:185-90
Rodriguez-Infante A, Granero-Castro P, Alvarez-Pérez JA, et al. Atypical localization in Boerhaave’s síndrome. Rev Esp Enferm Dig 2012; 104: 555-7.
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Ferreiro-Iglesias R, Blanco Freire M, Paz Novo M, Domínguez Muñoz J. Boerhaave’s syndrome: diagnostic gastroscopy. 4242/2016


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Publication history

Received: 01/02/2016

Accepted: 07/02/2016

Published: 03/01/2017

Article editing time: 337 days


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