Boerhaave syndrome (also called Boerhaave's syndrome) is rupture of the esophagus. It is generally caused by excessive vomiting in eating disorders such as bulimia although it may rarely occur in extremely forceful coughing or other situations. It can cause pneumomediastinum and/or mediastinitis (air or inflammation of the mediastinum) and sepsis. This condition was first documented by the 18th-century physician Herman Boerhaave, after whom it is named. The esophagus (also spelled oesophagus/œsophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... Bulimia nervosa, more commonly known as bulimia, is a psychological condition in which the subject engages in recurrent binge eating followed by intentionally doing one or more of the following in order to compensate for the intake of the food and prevent weight gain: vomiting inappropriate use of laxatives, enemas... Pneumomediastinum (Source: http://www. ... Mediastinitis is inflammation of the tissues in the mediastinum. ... FIG. 967– Transverse section through the upper margin of the second thoracic vertebra The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Herman Boerhaave (December 31, 1668 - September 23, 1738) was a Dutch humanist and physician of European fame. ...

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 iatrogenic perforation, which accounts for 85-90% of cases of esophageal rupture, typically as a complication of an endoscopic procedure, feeding tube, or unrelated surgery. Boerhaave syndrome is often seen as a complication of Bulimia. Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... The esophagus (also spelled oesophagus/Å“sophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... Mallory-Weiss Syndrome refers to bleeding from tears in the mucosa at the junction of the stomach and esophagus, usually caused by severe retching, coughing, or vomiting. ... An iatrogenic (pronounced , IPA) condition is a state of ill health or adverse effect caused by medical treatment, usually due to mistakes made in treatment. ... Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center. ...

The classic Meckler's triad of symptoms includes vomiting, lower chest pain, and cervical subcutaneous emphysema following overindulgence in food or alcohol, but is observed in only half of the cases. The most common chest radiograph findings in spontaneous esophageal rupture (SER) are pleural effusion (91%) and pneumothorax (80%). The initial sign on a plain film may be pneumomediastinum or subcutaneous emphysema. Up to 12% of patients with SER may have a normal chest radiograph. Contrast-enhanced esophageal radiography is diagnostic in 75% to 85% of cases.^[1] Functional group of an alcohol molecule. ... Radiography is the creation of radiographs, photographs made by exposing a photographic film or other image receptor to X-rays. ... Pleural effusion Chest x-ray of a pleural effusion. ... Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place. ... Pneumomediastinum (Source: http://www. ...

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 sphincter within 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 left posterolateral wall of the lower third of the esophagus, 2-3 cm before the stomach. Look up Sphincter in Wiktionary, the free dictionary. ... In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ...

Treatment

Its treatment includes immediate antibiotic therapy to prevent mediastinitis and sepsis, surgical repair of the perforation, and if there is significant fluid loss it should be replaced with IV fluid therapy since oral rehydration is, obviously, not possible. Staphylococcus aureus - Antibiotics test plate. ... Mediastinitis is inflammation of the tissues in the mediastinum. ... Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...

Notes

1. ^ S. Herman, H. Shanies, H. Singh & M. Warshawsky: "Spontaneous Esophageal Rupture: Boerhaave's Syndrome," pages 177-182. Clinical Pulmonary Medicine 10(3), May 2003

References

• Cecil Textbook of Medicine
• eMedicine free password needed
• The Oxford Textbook of Medicine