esophageal perforation (Boerhaave syndrome)
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Etiology
- carcinoma
- foreign body
- chemical burns
- instrumentation
- severe retching & vomiting
Pathology
- rupture of the esophagus resulting from increased esophageal lumenal pressure during vomiting against a closed glottis
- mediastinitis results
- rupture into the left pleural space may occur
Clinical manifestations
- Mackler triad
- retrosternal pain with radiation to the back & epigastrium
- abdominal rigidity (intra-abdominal perforation)
- hematemesis
- melena
- fever
- tachycardia, tachypnea
- shock
Laboratory
- complete blood count (CBC)
- endoscopy to identify esophageal laceration
- pleural fluid (thoracentesis)
Radiology
- anterior displacement of the trachea
- pleural effusion
- pneumothorax
- mediastinal emphysema (occasional)