Boerhaave syndrome

Boerhaave syndrome (also called Boerhaave's syndrome) is rupture of the esophagus. It is generally caused by excessive vomiting, although it may rarely occur in extremely forceful coughingor other situations. It can cause pneumomediastinumand/or mediastinitis(air or inflammation of the mediastinum) and sepsis. This condition was first documented by Herman Boerhaaveafter whom it is named.

Symptoms

It typically occurs after forceful vomiting. Boerhaave syndrome is a transmural perforation (full-thickness; a hole) of the esophagus, distinct from Mallory-Weiss syndrome, a nontransmural esophageal tear also associated with vomiting. Because it is generally associated with vomiting, Boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from iatrogenicperforation, which accounts for 85-90% of cases of esophageal rupture, typically as a complication of an endoscopicprocedure, feeding tube, or unrelated surgery.

Pathophysiology

Esophageal rupture in Boerhaave syndrome is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle (a sphincterwithin the esophagus) to relax. The syndrome is commonly associated with the consumption of excessive food and/or alcohol. The most common anatomical location of the tear in Boerhaave syndrome is at the left posterolateral wall of the lower third of the esophagus, 2-3 cm before the stomach.

Treatment

Its treatment includes immediate antibiotic therapyto prevent mediastinitisand sepsis, surgical repair of the perforation, and if there is significant fluid loss it should be replaced with IV fluid therapysince oral rehydration is, obviously, not possible.

References

• Cecil Textbook of Medicine
• eMedicinefree password needed
• The Oxford Textbook of Medicine

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Boerhaave+syndrome Wikipedia article Boerhaave syndrome.