Boerhaave syndrome pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2] Shaghayegh Habibi, M.D.[3]
Overview
Boerhaave syndrome is a spontaneous longitudinal perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. It is commonly associated with the consumption of excessive food and/or alcohol or underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett's or infectious ulcers.
Pathophysiology
Pathogenesis
- Boerhaave syndrome is a spontaneous perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. Some situations that can induce Boerhaave syndrome include:[1]
- In Boerhaave syndrome, the spontaneous transmural perforation may be as a result of neuromuscular incoordination resulting in a longitudinal esophageal perforation.[2]
- The most common anatomical location of the esophageal perforation in Boerhaave syndrome is at the left posterolateral wall of the distal intrathoracic esophagus (the distal third of the esophagus is inherently weaker than the rest of the esophagus) and 2-3 cm before the stomach. However, the esophageal perforation in Boerhaave syndrome can also occur in the cervical or intra-abdominal esophagus.[3]
Associated conditions
- Boerhaave syndrome usually occurs in patients with a normal underlying esophagus while some patients have underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett's or infectious ulcers.[4][5]
- Boerhaave syndrome is commonly associated with the consumption of excessive alcohol or over eating, or both. Either of these can induce vomiting.[6][7]
Gross pathology
- In Boerhaave syndrome the gross pathology is based on the underlying condition of esophagus which could be normal, eosinophilic esophagitis, Barrett's or infectious ulcer.
Microscopic pathology
- In Boerhaave syndrome the microscopic pathology is based on the underlying condition of the esophagus which could be normal, eosinophilic esophagitis, Barrett's or infectious ulcer.
References
- ↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
- ↑ Yang W, Sahota RS, Das S (January 2018). "Snap, crackle and pop: when sneezing leads to crackling in the neck". BMJ Case Rep. 2018. doi:10.1136/bcr-2016-218906. PMID 29335355.
- ↑ Razi E, Davoodabadi A, Razi A (2013). "Spontaneous esophageal perforation presenting as a right-sided pleural effusion: a case report". Tanaffos. 12 (4): 53–7. PMC 4153269. PMID 25191485.
- ↑ Jackson WE, Mehendiratta V, Palazzo J, Dimarino AJ, Quirk DM, Cohen S (2013). "Boerhaave's syndrome as an initial presentation of eosinophilic esophagitis: a case series". Ann Gastroenterol. 26 (2): 166–169. PMC 3959943. PMID 24714779.
- ↑ Straumann A, Bussmann C, Zuber M, Vannini S, Simon HU, Schoepfer A (May 2008). "Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients". Clin. Gastroenterol. Hepatol. 6 (5): 598–600. doi:10.1016/j.cgh.2008.02.003. PMID 18407800.
- ↑ Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B (March 2013). "Boerhaave's syndrome: diagnosis and successful primary repair one month after the oesophageal perforation". Ghana Med J. 47 (1): 53–5. PMC 3645189. PMID 23661858.
- ↑ Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B (March 2013). "Boerhaave's syndrome: diagnosis and successful primary repair one month after the oesophageal perforation". Ghana Med J. 47 (1): 53–5. PMC 3645189. PMID 23661858.