Gastroenterology

Boerhaave Syndrome song

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Boerhaave Syndrome

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Boerhaave syndrome is spontaneous esophageal perforation caused by sudden rise in intraesophageal pressure, most commonly from forceful vomiting.
The classic triad (Mackler triad) is vomiting, chest pain, and subcutaneous emphysema.
The most common site of perforation is the left posterolateral wall of the distal esophagus, just above the gastroesophageal junction.
Subcutaneous emphysema in the neck or chest after vomiting is a pathognomonic clinical clue.
Hamman sign (mediastinal crunch synchronous with heartbeat) is a classic auscultatory finding caused by mediastinal emphysema.
Chest X-ray may show pneumomediastinum, pleural effusion (left-sided), or hydropneumothorax; CT chest with oral contrast is the preferred confirmatory imaging.
Water-soluble contrast esophagography (Gastrografin swallow) is the initial diagnostic test of choice; if negative, barium swallow can follow for higher sensitivity.
Boerhaave syndrome carries the highest mortality of all esophageal perforations due to rapid mediastinitis and sepsis if untreated.
Treatment within 24 hours is primary surgical repair; after 24 hours or in unstable patients, esophageal stenting, drainage, or esophagectomy may be required.
Distinguish from Mallory-Weiss syndrome, which involves only mucosal tears at the GEJ and presents with hematemesis but no perforation or mediastinitis.