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Prolonged Emesis Causing Esophageal Perforation: A Case Report.

Nandita Kakar¹, Harrison C Smith¹, Anthony M Shadid²

¹Medicine, Nova Southeastern University Dr. Kiran C. Patel College Of Osteopathic Medicine, Fort Lauderdale, USA.

|June 8, 2022

Summary

Boerhaave syndrome, a severe esophageal rupture, has high mortality due to delayed diagnosis. Prompt treatment within 24 hours, including surgical repair and drainage, significantly improves survival rates.

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Area of Science:

Gastroenterology
Thoracic Surgery
Emergency Medicine

Background:

Transmural esophageal rupture, or Boerhaave syndrome, presents significant diagnostic and management challenges.
Patient heterogeneity in age, comorbidities, and illness severity complicates clinical decision-making.
Distal esophageal rupture can lead to mediastinal necrosis and bacterial infection from gastric content leakage.

Observation:

Delayed diagnosis and treatment are primary contributors to the high mortality associated with Boerhaave syndrome.
Symptoms are often heterogeneous, making early recognition difficult.
The condition involves leakage of gastric contents into the thoracic cavity, causing severe complications.

Findings:

Prompt detection and intervention, including conservative care and/or surgical repair, are crucial for managing Boerhaave syndrome.

Keywords:

boerhaave syndrome crepitus emesis esophageal perforation subcutaneous emphysema

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Early recognition within 24 hours is critical for optimal outcomes.

Primary esophageal repair combined with mediastinal and chest drainage within 24 hours is linked to a 90% survival rate.

Implications:

Emphasizes the critical need for rapid diagnosis and intervention in esophageal rupture cases.
Highlights the importance of timely surgical repair and drainage for improving patient survival.
Suggests that adherence to a strict treatment timeline can dramatically reduce mortality in Boerhaave syndrome.