Abstract
Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus, usually in its distal part. It generally develops during or after persistent vomiting as a consequence of a sudden increase in intraluminal pressure in the esophagus. It is extremely rare in clinical practice. In 50% of the cases, it is manifested by Mackler's triad: vomiting, lower thoracic pain and subcutaneous emphysema. Hematemesis is an uncommon yet challenging presentation of Boerhaave's syndrome. Compared with ruptures of other parts of the digestive tract, spontaneous rupture is characterized by a higher mortality rate. This paper presents a 64-year-old female patient whose vomit was black four days before examination and became bloody on the day of the examination. Her symptoms included epigastric pain and suffocation. Physical examination showed hypotension, tachycardia, dyspnea and a swollen and painful abdomen. Auscultation showed lateral crackling sounds on inspiration. Ultrasound examination showed a distended stomach filled with fluid. Over 1000 ml of fresh blood was extracted by means of nasogastric suction. Esophagogastroduodenoscopy was discontinued immediately upon entering the proximal esophagus, where a large amount of fresh blood was observed. The patient was sent for emergency abdominal surgery, during which she died. An autopsy established a diagnosis of Boerhaave syndrome and ulceration in the duodenal bulb. Boerhaave syndrome should be considered in all cases with a combination of gastrointestinal symptoms (especially epigastric pain and vomiting) and pulmonary signs and symptoms (especially suffocation).
Highlights
Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus
The syndrome is named after a German doctor, Herman Boerhaave, who first described it in 1724.1 In comparison with iatrogenic rupture, which may develop during diagnostic or therapeutic endoscopic procedures, traumas or various esophageal diseases, spontaneous rupture most commonly develops during or after persistent vomiting, as a consequence of a sudden increase in intraluminal esophageal pressure
Considering that spontaneous rupture most often happens in the distal esophagus, the majority of patients have Mackler’s triad of symptoms and signs: vomiting, lower thoracic pain and subcutaneous emphysema.[3,4]
Summary
Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the esophagus. CASE REPORT The patient was a 64-year-old female, with a history of long-term arterial hypertension, who was brought to the Gastroenterology and Hepatology Clinic of the Niš Clinical Center by the emergency medical services She was admitted presenting with vomiting of fresh blood, black stools, epigastric pain, suffocation and exhaustion. On the day of admission, after vomiting an excessive amount of black substance, she developed a pain in the epigastric region and began to vomit fresh blood It was at this stage that she rang the emergency medical services. Physical examination showed that the patient was alert, adynamic, tachycardiac and dyspneic, and her skin was pale Her blood pressure was 60/40 mmHg. Auscultation of the heart was normal. The autopsy report declared that the immediate cause of death was hemopneumothorax due to esophageal injury and a chronic duodenal ulcer
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