Boerhaave Syndrome-Unusual Cause of Chest Pain

Abstract

Spontaneous esophageal rupture (Boerhaave syndrome) is uncommon in children. Delayed or missed diagnosis can lead to poor outcomes in terms of morbidity and mortality. To highlight the importance of early recognition and management of spontaneous esophageal rupture in children, we report a case of a 16-year-old boy who presented in the emergency department with acute chest pain after episodes of vomiting.

Tratamiento conservador del síndrome de Boerhaave en un octogenario complicado con estenosis esofágica distal tardía y tratado con éxito mediante colocación de stent

“…Other rare causes are asthma, seizures, and childbirth, which also increase the intra-abdominal pressure. Esophagus lacks serosal layer that acts protectively, making it prone to rupture 2,8 . The location of rupture is mainly in the left lower third of the esophagus 7 , as was in our patient.…”

“…The diagnostic tools for Boerhaave's syndrome are chest X-ray, contrast esophagography, esophagoscopy, and thoracic CT scan 1 . More specifically, chest X-ray may reveal hydropneumothorax, pneumothorax, pneumomediastinum, pleural effusion, subcutaneous emphysema, or widened mediastinum 2,5 , while contrast esophagography may show contrast media extravasation 11 and is considered to be the gold standard 12 . Esophagoscopy is as sensitive as esophagography, but it needs to be carefully Treatment of Boerhaave's syndrome remains controversial.…”

“…Boerhaave's syndrome or spontaneous esophageal perforation is an uncommon but potentially fatal condition, as it may lead to severe mediastinitis, sepsis, and consequently multiple organ failure 1 . It usually manifests in adult (40-60 years old) 2 alcoholic male patients 3 . Its symptoms are usually non typical, while the Mackler triad with vomiting, chest pain, and subcutaneous emphysema is found in < 33% of the cases 1,4 .…”

Pneumomédiastin spontané chez un adolescent: place des examens complémentaires

“…La rupture spontanée de l'oesophage touche plus souvent l'homme entre 40 et 60 ans, mais des cas chez l'enfant et l'adolescent ont été observés [8]. La triade de Mackler (douleur thoracique, vomissements et emphysème sous-cutané) considérée comme très spécifique de la rupture spontanée de l'oesophage [9] ne permet pourtant pas le diagnostic de certitude, car il existe de nombreux points communs entre le tableau clinique du syndrome de Boerhaave et celui du PMS.…”

Neumomediastino secundario a efecto Macklin. Reporte de un caso

“…1,2 En niños y adultos el neumomediastino es una patología poco frecuente (aproximadamente de 1/800 a 1/42,000 consultas a urgencias) relacionada con traumatismos en la vía aeréa, 3 rupturas esofági-cas por aumentos de la presión intraabdominal (vómitos), el llamado síndrome de Boerhaave de alta morbimortalidad, 4 crisis asmática y a infecciones de la vía respiratoria, traumatismos, vómitos, esfuerzos intensos, estados de ansiedad con hiperventilación o espontáneo, en aquellos casos que no presentan relación con trauma o lesión iatrogénica. 1,2,5 En 1939 Charles Macklin reportó el proceso fisiopatológico en el que la ruptura alveolar es la responsable del neumomediastino.…”