[An unusual case of Boerhave syndrome. Esophageal rupture during preparation for gastroscopy]

A 72-year-old woman who had been given heavy premedication nonetheless developed severe retching at the beginning of a gastroscopy (for suspected gastric ulcer) when the instrument had been advanced only as far as the throat. The investigation was at once terminated, but barium swallow immediately afterwards revealed rupture at the middle third of the oesophagus, with contrast medium flowing into the mediastinum. Despite emergency thoracotomy and suturing of a 4 cm long fresh oesophageal tear in the area of a diverticulum, the patient died from a purulent mediastinitis and confluent pneumonia. The cause of this "spontaneous" rupture of the oesophagus without direct transmission of force (Boerhaave syndrome) in this case was a marked pressure increase in the oesophagus from retching and hyperperistalsis preparatory to gastroscopy. There had definitely not been any instrumental perforation. There was thus no medical negligence.