[Boerhaave syndrome]

Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.