Abstract
BackgroundSpontaneous rupture of the esophagus (Boerhaave's syndrome) is a rare, well-defined clinical syndrome caused by a longitudinal perforation of the esophagus. It is a life-threatening condition that necessitates rapid diagnosis and treatment. Patients typically present acutely with a history of vomiting followed by chest or abdominal pain. However, the diagnosis may be difficult or missed when patients present with chronic symptoms that mimic other conditions.Case PresentationIn this report, we present a unique case of Boerhaave's syndrome in a 53-year-old male patient. In contrast to the more common acute presentation, our patient developed non-specific symptoms in association with an intrathoracic cyst. In this report, we will also review the usual presenting signs, symptoms, and treatment of Boerhaave's syndrome.ConclusionOur emphasis in this paper will be on the importance of recognizing and diagnosing Boerhaave's syndrome in an acute as well as a chronic state.
Highlights
Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a rare, well-defined clinical syndrome caused by a longitudinal perforation of the esophagus
Boerhaave's Syndrome is a condition of spontaneous, longitudinal esophageal tear due to the elevated intraesophageal pressure that that classically follows repeated episodes of vomiting
Presentations of esophageal perforation can be distinguished as acute, subacute, and chronic
Summary
Boerhaave's Syndrome is a condition of spontaneous, longitudinal esophageal tear due to the elevated intraesophageal pressure that that classically follows repeated episodes of vomiting. Presentations of esophageal perforation can be distinguished as acute, subacute, and chronic. Nonoperative treatment is best for patients with a contained perforation and the absence of clinical mediastinitis [10,11]. Such therapy usually includes targeted drainage, intravenous antibiotics, nasogastric decompression, and enteral nutrition. The patient was treated with targeted drainage, intravenous antibiotics, nasogastric decompression, and enteral nutrition. He became septic two days after the EGD, and required emergency thoracotomy with distal esophagectomy following several days later. After ashort term of ventilator support and parenteral nutrition, he was weaned off of fboth, and was discharged with a PEG tube for enteral feedings, and is currently being evaluated for esophagostomy reversal
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