Table 2 Major co-morbidities were not greater when diagnosis was delayed <24 h >24 h to presentation to presentation No major co-morbidities 7  7 Major co-morbidities 5 15 <24 h >24 h to presentation to presentation No major co-morbidities 7  7 Major [academic.oup.com]

All clinicians need to be aware of this lethal disease, its frequently unusual presentations and the importance of early diagnosis. [pmj.bmj.com]

To deal with single incident cases, a treatment algorithm is composed and presented in Figure 4. [hindawi.com]

It has traditionally been associated with important vomiting or the Valsalva maneuver, and its clinical presentation is intense pain and emphysema, even though it can present without these symptoms. [revistagastroenterologiamexico.org]

Diagnosis of Boerhaave syndrome can be difficult, because often no classic symptoms are present and delays in presentation for medical care are common. [1] Although Boerhaave syndrome classically presents as the Mackler triad of chest pain, vomiting, [emedicine.medscape.com]

• Pain

  Chest pain and vomiting: Beware of Boerhaave syndrome. Med Emergency, MJEM 2016; 24:22-5. [mjemonline.com]

  Case presentation Case 1 A 45-year-old man with a history of hypertension, dyslipidemia, and habitual drinking visited our hospital with complaints of severe chest pain, back pain, bilateral shoulder pain, and vomiting. [intjem.biomedcentral.com]

  They are often associated with the clinical triad (Mackler's triad) of vomiting, chest pain and subcutaneous emphysema. Other symptoms include epigastric pain, back pain, dyspnea and shock. [radiopaedia.org]

  Symptoms in all of them began with intense abdominal pain. One of the patients was awakened by the pain and it appeared after ingestion in 3 other patients. [revistagastroenterologiamexico.org]

  Diagnosis is challenging as the classic triad of vomiting, abdominal or chest pain, and subcutaneous emphysema is absent in many patients. Management is multidisciplinary and relies on rapid, distinct, and repeated imaging. [hindawi.com]

• Sepsis

  Sepsis, respiratory failure No No  0 49 77  7 Primary repair Sepsis, AF, empyema, 16  8 16 16 DVT, respiratory failure 75  2 Surgical debridement Sepsis, AF, ARF, cardiac  1  2 10 10 84 <1 Primary repair AF, sepsis 20 28 31 31 77  8 Primary repair Sepsis [academic.oup.com]

  Based on time of presentation and eventual presence of sepsis, a therapeutic algorithm is proposed. 1. [hindawi.com]

  Complications acute mediastinitis esophagopleural fistula pneumonia empyema sepsis History and etymology It is named after Hermann Boerhaave (1668-1738), a Dutch professor of clinical medicine 4,8. [radiopaedia.org]

  And the last case studied presented as sepsis originating in the abdomen. Four cases (57%) had early diagnosis (< 24hours after symptom onset), whereas the other 3 cases (43%) had late diagnosis. [revistagastroenterologiamexico.org]

  Nonetheless, prompt recognition of this potentially lethal condition is vital to ensure appropriate treatment. [1] Mediastinitis, sepsis, and shock are frequently seen late in the course of the illness, which further confuses the diagnostic picture. [emedicine.medscape.com]

• Fever

  Fever may be present or not. Auscultation occasionally reveals decreased breath sounds on the perforation side. [hindawi.com]

• Falling

  This falls to 35-50% if surgery is delayed longer than 24 hours and to approximately 10% if delayed longer than 48 hours. Therefore, early diagnosis and intervention of esophageal perforation significantly reduces mortality. [emedicine.medscape.com]

• Asymptomatic

  In asymptomatic patients, the conservative management consists in a continuous positive pressure ventilation. In intubated patients, it is prudent to wait between 4 and 6 weeks; if it persists, the benefit of diaphragmatic plication is discussed. [websurg.com]

• Pleural Effusion

  The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. [ejcrim.com]

  The classic chest radiographic findings include pneumomediastinum, left pleural effusion and left pneumothorax. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. [radiopaedia.org]

  Plain chest X-rays may reveal subcutaneous and/or mediastinal emphysema, mediastinal widening, pleural effusion(s), pneumothorax, hydrothorax, and intrathoracic air-fluid levels or masses [5]. [hindawi.com]

  In regard to the diagnostic tests, a chest x-ray was taken in all the cases, detecting left pleural effusion in 6 cases (86%) and bilateral pleural effusion in one case (14%). [revistagastroenterologiamexico.org]

  The diagnosis was chosen after performing chest radiography followed by thoraco-abdominal scanner that was able to highlight a left pneumothorax and pneumomediastinum associated with bilateral pleural effusion. [mjemonline.com]

• Dyspnea

  We report the case of a 74 year old patient victim of dyspnea associated with left/posterior latero-thoracic oppressive pain, after repeated attempts to vomiting. [mjemonline.com]

  Other symptoms include epigastric pain, back pain, dyspnea and shock. This condition was universally fatal before the age of surgery. [radiopaedia.org]

  Male, Chronic Gallstone Pancreatitis, Open Cholecystectomy 100 pack/year smoker Dyspnea 1 block More information ANTICANCER RESEARCH 34: (2014) The Impact of Combined Thoracoscopic and Laparoscopic Surgery on Pulmonary Complications After Radical Esophagectomy [healthdocbox.com]

  Case Report A 41-year-old man with an extensive medical history, including Child-Pugh B liver cirrhosis and chronic pancreatitis, consulted his family doctor with progressive dyspnea, retrosternal pain radiating to the back, repeated vomiting, and fever [hindawi.com]

  Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. [intjem.biomedcentral.com]

• Respiratory Distress

  However, up to one-third of patients have atypical symptoms or are admitted with severe respiratory distress and/or shock. [hindawi.com]

  Other complications include acute respiratory distress syndrome, pneumomediastinum, pneumothorax, and hydrothorax. Turner AR, Turner SD. Boerhaave syndrome. StatPearls [Internet]. 2018 Jan. [Medline]. [Full Text]. Korn O, Onate JC, Lopez R. [emedicine.medscape.com]

• Cough

  In our study, the clinical presentation appeared subsequent to vomiting in 3 cases, it was related to the effort of coughing in 2 cases, and in one case it was associated with the effort of a prior bowel movement. [revistagastroenterologiamexico.org]

• Decreased Breath Sounds

  Auscultation occasionally reveals decreased breath sounds on the perforation side. [hindawi.com]

• Vomiting

  Chest pain and vomiting: Beware of Boerhaave syndrome. Med Emergency, MJEM 2016; 24:22-5. [mjemonline.com]

  Case presentation The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. [intjem.biomedcentral.com]

  They are often associated with the clinical triad (Mackler's triad) of vomiting, chest pain and subcutaneous emphysema. Other symptoms include epigastric pain, back pain, dyspnea and shock. [radiopaedia.org]

  The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural [ejcrim.com]

  The classic clinical symptoms are vomiting, chest pain, and subcutaneous emphysema, known as Mackler's triad. [revistagastroenterologiamexico.org]

• Nausea

  Case presentation The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. [intjem.biomedcentral.com]

  Results Of the 34 patients treated for Boerhaave's syndrome, 22 had initial history of nausea and vomiting and eight a history of gastro-oesophageal reflux disease. The presence of a hiatus hernia was found at operation in these eight. [academic.oup.com]

• Epigastric Pain

  Other symptoms include epigastric pain, back pain, dyspnea and shock. This condition was universally fatal before the age of surgery. [radiopaedia.org]

  It is uncommon for patients to present with the classic triad of retching, sudden epigastric pain and shock, hence causing delayed diagnosis. However, the outcome relies heavily on prompt diagnosis and treatment. [academic.oup.com]

• Dysphagia

  Most treatment options available for the relief or treatment of dysphagia can be performed endoscopically.but can also be caused by Various modalities are currently available for the relief of dysphagia caused by malignant esophageal stricturesThe options [slideshare.net]

• Hematemesis

  At first, Mallory–Weiss syndrome was suggested because of hematemesis, but CT suggested Boerhaave syndrome. No hematemesis recurred during his hospitalization, and his condition was followed up on via esophagogram and CT. [intjem.biomedcentral.com]

• Ulcer

  The differential diagnosis of Boerhaave’s syndrome includes a variety of acute thoracic and abdominal conditions including myocardial infarction, pulmonary embolus, dissecting aorta, ruptured aortic aneurysm, perforated peptic ulcer, Mallory-Weiss syndrome [hindawi.com]

  A portion of these patients may have underlying peptic ulcer disease, eosinophilic esophagitis, medication-induced esophagitis, or Barrett esophagus. No genetic predilection is apparent. [emedicine.medscape.com]

• Seizure

  Other reported but less likely causes of Boerhaave syndrome include caustic ingestion, childbirth, seizures, weightlifting, trauma, and medical instrumentation. [emedicine.medscape.com]

• Left Pleural Effusion

  The classic chest radiographic findings include pneumomediastinum, left pleural effusion and left pneumothorax. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. [radiopaedia.org]

  With respect to imaging studies, chest x-ray is indispensible.7,8 Left pleural effusion is practically a constant factor in this event, as our study reflected. [revistagastroenterologiamexico.org]

  A control CT scan demonstrated a left-sided paravertebral encapsulated air-fluid collection and a left pleural effusion that had substantially increased in size. A pigtail catheter was inserted into the left pleural space. [hindawi.com]

• Right Pleural Effusion

  A new chest X-ray revealed a rapidly evolving right pleural effusion (Figure 3). Subsequently, the patient was intubated and mechanically ventilated. A chest tube was inserted in the right pleural space. A brown, foul-smelling fluid was evacuated. [hindawi.com]

• Pleural Effusion

  The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. [ejcrim.com]

  The classic chest radiographic findings include pneumomediastinum, left pleural effusion and left pneumothorax. Gas may also be seen with the soft tissue spaces of the chest wall and the neck. [radiopaedia.org]

  Plain chest X-rays may reveal subcutaneous and/or mediastinal emphysema, mediastinal widening, pleural effusion(s), pneumothorax, hydrothorax, and intrathoracic air-fluid levels or masses [5]. [hindawi.com]

  In regard to the diagnostic tests, a chest x-ray was taken in all the cases, detecting left pleural effusion in 6 cases (86%) and bilateral pleural effusion in one case (14%). [revistagastroenterologiamexico.org]

  The diagnosis was chosen after performing chest radiography followed by thoraco-abdominal scanner that was able to highlight a left pneumothorax and pneumomediastinum associated with bilateral pleural effusion. [mjemonline.com]

It is a rare but life-threatening condition that requires urgent diagnosis and treatment. [hindawi.com]

The severity of illness was also quite varied, regardless of time interval between injury and treatment. [academic.oup.com]

The choice between surgery or conservative treatment depends on many factors. [revistagastroenterologiamexico.org]

The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. [ejcrim.com]

Surgery is the gold standard treatment. However, there is an emerging use of conservative methods, namely esophageal stenting. Mortality can be as low as 6.2% when identified and treated in the first 24 hours 11. [radiopaedia.org]

Early diagnosis governs the appropriate repair and the vial prognosis. [orbi.uliege.be]

The combined advancement of medical imaging and surgical techniques have greatly improved the prognosis of these patients especially in case of early treatment. Full article [mjemonline.com]

[…] and retroperitoneal spaces esophageal perforation from iatrogenic injury Mallory-Weiss tear: partial thickness tear epiphrenic diverticulum: mimicking pneumomediastinum esophageal or pulmonary malignancy causing esophagopleural fistula Treatment and prognosis [radiopaedia.org]

Prognosis The prognosis of Boerhaave syndrome is directly contingent on its early recognition and appropriate intervention. [1] Early diagnosis allows prompt surgical repair. [emedicine.medscape.com]

[…] crucial to correctly distinguish Boerhaave syndrome from Mallory–Weiss syndrome as they share similar etiologies and initial clinical manifestations; however, they differ with respect to the site and depth of laceration, treatment administered, and prognosis [intjem.biomedcentral.com]

The etiologies of both Boerhaave and Mallory–Weiss syndromes are similar, both result from abnormally elevated intraluminal cardio-esophageal pressure during vomiting. [intjem.biomedcentral.com]

Its etiology involves a sudden increase in the intraesophageal pressure. The classic clinical symptoms are vomiting, chest pain, and subcutaneous emphysema, known as Mackler's triad. [revistagastroenterologiamexico.org]

Etiology Boerhaave syndrome is a barogenic injury resulting from a sharp increase in the intraluminal pressure against a closed cricopharyngeus. [emedicine.medscape.com]

Epidemiology, pathophysiology, diagnosis. Pol Przegl Chir 2016;88:359–364. Rokicki M, Rokicki W, Rydel M. Boerhaave's syndrome - over 290 yrs of surgical experiences. Surgical, endoscopic and conservative treatment. Pol Przegl Chir 2016;88:365–372. [ejcrim.com]

Epidemiology International data Although it is likely underreported, the incidence of Boerhaave syndrome is relatively rare, with an estimated incidence of 3.1 per 1,000,000 persons per year. [4] Among esophageal perforations, aproximately 15% are spontaneous [emedicine.medscape.com]

Epidemiology, pathophysiology, diagnosis. Pol Przegl Chir 2016;88:359–364. Rokicki M, Rokicki W, Rydel M. Boerhaave's syndrome - over 290 yrs of surgical experiences. Surgical, endoscopic and conservative treatment. Pol Przegl Chir 2016;88:365–372. [ejcrim.com]

Diagnostic considerations in mediastinal emphysema: a pathophysiologic-roentgenologic approach to Boerhaave's syndrome and spontaneous pneumomediastinum. Am J Roentgenol Radium Ther Nucl Med. 1972 Jul. 115(3):495-511. [Medline]. Rozycki GS. [emedicine.medscape.com]

Regarding pathophysiology, Mallory–Weiss lacerations are caused by repeated retching and primarily involve the part of the gastric cardia that includes the EGJ. [intjem.biomedcentral.com]

The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment. [ejcrim.com]

The double-type Niti-S stent (Taewoong Medical)A fully covered inner nitinol stent prevents tumor ingrowth, and an outer uncovered nitinol sleeve in the mid-portion of the stent is meant to prevent migration, thus combining the best properties of both [slideshare.net]

The injury healed after conservative treatment that included rest, no oral consumption, and preventive antibiotics. He was discharged on the 11th day. Fig. 4 Plain CT on arrival in case 2 (a transverse section; b sagittal section). [intjem.biomedcentral.com]

The longer the delay, the more tissue necrosis and oedema are present, perhaps preventing successful repair. [academic.oup.com]