Boerhaave Syndrome Causing Bilateral Empyemas.

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Boerhaave syndrome is a catastrophic esophageal perforation typically linked to sudden intraluminal pressure increases.
• While commonly associated with left-sided pleural effusion and mediastinitis, bilateral effusions are exceptionally rare.
• The relationship between Boerhaave syndrome and hiatal hernias remains incompletely understood.

Observation:

• A patient with a known hiatal hernia presented with a rare manifestation of Boerhaave syndrome.
• The patient developed bilateral empyemas, a complication not typically seen in this condition.
• This clinical scenario presented a diagnostic and therapeutic challenge.

Findings:

• The patient's bilateral empyemas were confirmed to be secondary to Boerhaave syndrome.
• The presence of a hiatal hernia did not preclude the development of bilateral empyemas in this case.
• Successful management was achieved using an endoscopically placed esophageal stent.

Implications:

• This case expands the known spectrum of Boerhaave syndrome presentations, including bilateral empyema in patients with hiatal hernias.
• It underscores the importance of considering esophageal perforation in patients with unexplained bilateral pleural effusions.
• Endoscopic esophageal stenting offers a minimally invasive therapeutic option for complex Boerhaave syndrome cases.