Postemetic Rupture of Herniated Cardia of the Stomach

Abstract

THE CLASSIC description of postemetic or spontaneous rupture of the esophagus was recorded by a distinguished Dutch physician, Herman Boerhaave, in 1724.¹His patient, the Grand Admiral Baron van Wassenauer, experienced intense chest pain during induced vomiting at the conclusion of an eating and drinking episode. His general condition deteriorated rapidly and he died 18 hours later. At postmortem examination, Boerhaave found a rent in the lower third of the esophagus with a large quantity of gastric contents and air in the mediastinum and pleural cavity. In postemetic rupture of the esophagus, the perforation almost always occurs in the lower third, and in 90% of patients it is located posterolaterally on the left side. The etiology remains enigmatic, but it is conjectured that the extension of smoothmuscle fibers from the esophagus onto the stomach wall results in a defective or weakened muscular zone. The insufflation of air into the