esophageal perforation (Boerhaave syndrome)

Etiology

• carcinoma
• foreign body
• chemical burns
• instrumentation
• severe retching & vomiting
  • alcoholics
  • esophagitis

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
  • vomiting
  • lower chest pain
  • subcutaneous emphysema
• retrosternal pain with radiation to the back & epigastrium
• hematemesis
• melena
• fever
• tachycardia
• shock

Laboratory

• complete blood count (CBC)
• endoscopy to identify esophageal laceration
• pleural fluid (thoracentesis)
  • exudate effusion
  • elevated amylase (salivary)
  • pH generally diminished (as low as 7.00)
  • mesothelial cells variable

Radiology

• anterior displacement of the trachea
• pleural effusion
• pneumothorax
• mediastinal emphysema (occasional)

More general terms

• esophageal disease
• gastrointestinal perforation

Additional terms

• Mallory-Weiss tear