Boerhaave revisited: Spontaneous esophageal perforation as a diagnostic masquerader

Boerhaave-Mimicking Esophageal Perforation with Subsequent Esophagobronchial Fistula Formation as the Primary Manifestation of Crohn’s Disease

“…Henderson and Péloquin [9]focused attention on the fact that at least one third of patients do not show these classic symptoms. Under such circumstances, Boerhaave’s syndrome is often confused with myocardial infarction, aortic dissection, spontaneous pneumothorax, perforation of a peptic ulcer, pancreatitis or pulmonary embolus.…”

Esophageal perforations masked by steroids

“…The importance of prompt diagnosis and therapy of this entity is imperative [6], but delays can occur in patients, with atypical presentations, as described by Henderson and Peloquin [3] and others [4,5]. However, in our review of the literature, atypical or masked symptoms from steroid administration have not been discussed previously.…”

Belching and the development of Boerhaave’s syndrome

“…He described the classical symptomatology of initial gastric distress, sudden excruciating pain, followed by shock and death, in his classic clinicopathological descriptioǹ Atrocis, nec descripti prius, morbi historia' [2]. At presentation the disease could, however, very well be mistaken for myocardial infarction, pneumothorax, a dissecting aneurysm, mesenteric thrombosis or pancreatitis, since patients often have a history of heavy drinking, show left-sided pleural fluid and complain of abdominal and thoracic pain after vomiting [3]. Early recognition of Boerhaave's syndrome is important in view of high mortality if the diagnosis is delayed [1].…”

“…A chest X-ray is the most simple and fast initial test which will help to establish the diagnosis. However, mediastinal emphysema takes at least an hour to develop and the X-ray will remain normal in 10±12 % of the patients [3]. If clinical suspicion remains high with normal X-rays, swallow tests should be performed using Gastrografin or, when negative, barium.…”

“…One might also consider computed tomography as an initial approach in view of the increased risk of mediastinitis using barium. Once Boerhaave's syndrome is found to be present, surgery should be performed immediately, as delay increases mortality [1,3,4,5].…”