Boerhaave syndrome due to excessive alcohol consumption: two case reports

Abstract

Background Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room. Case presentation The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory–Weiss syndrome. Conclusion Owing to similar histories and symptoms, Boerhaave syndrome and Mallory–Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory–Weiss syndrome.

A Case Report of Conservatively Managed Boerhaave Syndrome

“…Moreover, mediastinal enlargement, along with air and fluid in the pleural spaces, can be detected on CT scans [7]. The mortality rate for Boerhaave syndrome ranges from 20% to 40%, and the presence of comorbidities such as alcohol abuse and cirrhosis increases the risk of morbidity and mortality [8][9][10]. The higher prevalence of differential diagnoses, such as perforated gastric or duodenal ulcer, acute myocardial infarction, pericarditis, pneumothorax, pulmonary thromboembolism, diaphragmatic hernia, dissecting aortic aneurysm, and acute pancreatitis, frequently impedes early diagnosis.…”

Mackler’s Triad: An Evolving Case of Boerhaave Syndrome in the Emergency Department

“…Boerhaave syndrome, or oesophageal rupture due to increased intraluminal oesophageal pressure, is a rare clinical syndrome with a high mortality of up to 40% [ 1 , 3 ], mostly attributed to severe local and systemic sepsis due to the leakage of food content from the esophagus. As in our case, a history of vomiting is the most frequent cause of spontaneous oesophageal perforation, but other events causing straining (such as childbirth, defecating, or weightlifting) can also lead to perforation [ 6 ]. This condition has a large predisposition towards men (82% of cases), and usually, patients are known with a history of significant alcohol intake (41% of cases) [ 7 ].…”

‘Bubbles and esophagus: A tale of unexpected and otherwise unexplained pain’

“…Boerhaave's syndrome is a rare and life-threatening emergency, defined as a spontaneous esophageal rupture caused by elevated intra-esophageal pressure. While forceful vomiting and retching are the most common causes of spontaneous esophageal rupture, other contributing factors can include weightlifting, abdominal trauma, defecation, and childbirth [1] . The clinical presentation often comprises the Mackler triad (vomiting, chest pain, and subcutaneous emphysema) [2] .…”