Boerhaave's syndrome as a complication of pre-existent gastrointestinal disease

Two cases of Boerhaave's Syndrome complicating vomiting of gastrointestinal obstruction are described. The successful management of each case is recounted and certain pitfalls noted. This association has received scant attention in the extensive literature on Boerhaave's Syndrome. We were not able to find a previous report of successful management of this dual pathology. Nevertheless, the location of two such cases at a District General Hospital within a decade suggests that it may not be exceptionally rare. We review the literature pertaining to the association of Boerhaave's Syndrome with pre-existent gastrointestinal disease. The suggestion is made that the possibility of a second surgical condition should be borne in mind when treating patients with this syndrome. We stress that the presence of symptoms due to pre-existent upper gastrointestinal disease may contribute to diagnostic delay in the recognition of Boerhaave's Syndrome.