Boerhaave syndrome history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Ajay Gade MD[3]], Feham Tariq, MD [4]

Overview

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.

History and Symptoms

History

• Obtaining history gives important information in making a diagnosis of BHS.
• It provides an insight into the cause, precipitating factors, and associated comorbid conditions.
• A complete history will help determine the correct therapy and helps in determining the prognosis.
• The areas of focus should be on onset, duration, and progression of symptoms such as

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.

Soon after the perforation, patients can have odynophagia, dyspnea, fever, tachypnea, tachycardia, cyanosis, and hypotension on physical examination. A pleural effusion may also occur.

• 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.

It may also be audibly recognized as Hamman's sign.