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[Vomiting, upper abdominal pain and sepsis]

P Berchtold1, C Ruchti

  • 1Medizinische Universitätspoliklinik, Bern.

Praxis
|November 29, 1994
PubMed
Summary

A rare case of Boerhaave syndrome, a spontaneous esophageal rupture, led to fatal septic-toxic shock. Early diagnosis is critical for this life-threatening condition.

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Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Boerhaave syndrome is a spontaneous esophageal rupture, often presenting with severe abdominal and thoracic pain.
  • This condition is a surgical emergency with high mortality if not promptly diagnosed and treated.

Observation:

  • A 78-year-old male presented with acute abdomen, vomiting, and severe pain radiating to the back.
  • Initial laparotomy revealed adhesions, a distended stomach, and small intestine diverticula, but no perforation.
  • The patient rapidly deteriorated into septic-toxic shock with pleural effusion.

Findings:

  • Esophageal rupture (Boerhaave syndrome) was confirmed post-mortem.
  • Infection involved Vibrio vulnificus, Streptococcus viridans, Proteus, and Klebsiella species.
  • Autopsy revealed purulent peri-esophagitis, mediastinitis, and pleuritis, leading to multiorgan failure.

Implications:

  • This case highlights the critical importance of considering Boerhaave syndrome in patients with sudden onset of severe chest and abdominal pain after forceful vomiting.
  • Prompt recognition and management are crucial for improving outcomes in esophageal rupture.
  • The polymicrobial infection underscores the aggressive nature of complications associated with this syndrome.

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