Esophageal Rupture

Background:

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Boerhaave’s syndrome – specifically spontaneous rupture due to sudden increase in esophageal pressure classically with retching and vomiting

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May also occur due to trauma or iatrogenic causes

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Usually perforation at left posterolateral intrathoracic esophagus

Presentation:

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Classic – acute onset severe constant substernal chest pain with history of retching or vomiting

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Other presentations - neck pain if cervical esophageal perforation, epigastric radiating to shoulder or back if intrathoracic perforation

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Dyspnea, dysphagia, hematemesis

Physical Exam:

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Rapidly progressive sepsis and shock due to fulminant necrotizing mediastinitis, pneumonitis, or peritonitis

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Tacycardia, tachypnea, diaphoresis, fever, hypotension 

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Hammans crunch if mediastinal emphysema

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Cervical SQ emphysema

Diagnosis:

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Definitive is CT chest or contrast esophogram - mediastinal free air, pleural effusion

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XR is not sensitive, although 90% will show nonspecific abnormalities

Management:

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Surgical emergency

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Fluid resuscitation

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Broad spectrum parenteral antibiotics

References:

1.      

Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.

2.      

Triadafilopoulos, G. (2018, February 21). Boerhaave syndrome: Effort rupture of the esophagus.

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