Boerhaave syndrome

Jump to navigation Jump to search
Boerhaave syndrome
ICD-10 K22.3
ICD-9 530.4
DiseasesDB 9168
MeSH D004939

Boerhaave syndrome Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Boerhaave syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Boerhaave syndrome On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Boerhaave syndrome

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Boerhaave syndrome

CDC on Boerhaave syndrome

Boerhaave syndrome in the news

Blogs on Boerhaave syndrome

Directions to Hospitals Treating Boerhaave syndrome

Risk calculators and risk factors for Boerhaave syndrome

For patient information, click here

Editor in Chief: Liudvikas Jagminas, MD, FACEP [1] Phone: 401-729-2419

Synonyms and keywords:: Oesophageal rupture, esophageal perforation, esophageal rupture


Overview

Boerhaave syndrome (also called Boerhaave's syndrome), or Esophageal perforation, is rupture of the esophageal wall. 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.[1][2]

Symptoms

It typically occurs after forceful vomiting. Boerhaave syndrome is a transmural perforation (full-thickness; a hole) of the esophagus, distinct from Mallory-Weiss syndrome, a nontransmural esophageal tear also associated with vomiting.

Because it is generally associated with vomiting, Boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from iatrogenic perforation, which accounts for 85-90% of cases of esophageal rupture, typically as a complication of an endoscopic procedure, feeding tube, or unrelated surgery. Boerhaave syndrome is often seen as a complication of Bulimia.

It is associated with "Meckler's triad".[3][4]

Pathophysiology

Esophageal rupture in Boerhaave syndrome is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle (a sphincter within the esophagus) to relax. The syndrome is commonly associated with the consumption of excessive food and/or alcohol.

The most common anatomical location of the tear in Boerhaave syndrome is at left posterolateral wall of the lower third of the esophagus, 2-3 cm before the stomach.[5]

Diagnosis

Images shown below are courtesy of RadsWiki

Treatment

Its treatment includes immediate antibiotic therapy to prevent mediastinitis and sepsis, surgical repair of the perforation,[6] and if there is significant fluid loss it should be replaced with IV fluid therapy since oral rehydration is, obviously, not possible.

References

  1. Template:WhoNamedIt
  2. H. Boerhaave. Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta. Lugduni Batavorum; Ex officine Boutesteniana. 1724.
  3. S. Herman, H. Shanies, H. Singh & M. Warshawsky: "Spontaneous Esophageal Rupture: Boerhaave's Syndrome," pages 177-182. Clinical Pulmonary Medicine 10(3), May 2003 abstract
  4. Yang ST, Devanand A, Tan KL, Eng PC (2003). "Boerhaave's syndrome presenting as a right-sided pleural effusion". Ann. Acad. Med. Singap. 32 (3): 415–7. PMID 12854388.
  5. Korn O, Oñate JC, López R (2007). "Anatomy of the Boerhaave syndrome". Surgery. 141 (2): 222–8. doi:10.1016/j.surg.2006.06.034. PMID 17263979.
  6. Matsuda A, Miyashita M, Sasajima K; et al. (2006). "Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report". Journal of Nippon Medical School = Nihon Ika Daigaku zasshi. 73 (6): 341–5. PMID 17220586.

References


Template:Gastroenterology

de:Boerhaave-Syndrom

Template:WikiDoc Sources