Pneumomediastinum following esophageal rupture associated with hyperemesis gravidarum

Abstract

A patient was diagnosed with pneumomediastinum caused by an esophageal rupture during hyperemesis gravidarum. The woman, at 15 weeks' gestation, presented with hyperemesis gravidarum complicated by an episode of chest pain and disturbance of consciousness. Radiological examination revealed pneumomediastinum and subcutaneous emphysema. They are normally caused by either pulmonary or esophageal rupture. The esophageal etiology was suspected as more likely because of the severe vomiting accompanied with it. Although the clinical feature was quite complicated and esophageal rupture is generally a life-threatening disease, we chose conservative therapy which resulted in rapid recovery. The final diagnosis was confirmed by endoscopic examination performed after recovery. Pneumomediastinum during pregnancy is rare but it could be lethal. Careful and considerate assessments including surgical treatment should be necessary.

Severe long esophageal stricture following hyperemesis gravidarum

“…In contrast, cases of esophageal rupture accompanying vomiting due to hyperemesis gravidarum have also been reported occasionally (Table 2) [15][16][17][18][19][20][21]. These cases are thought to have been caused by a rise in esophageal pressure during vomiting.…”

Hamman and Boerhaave syndromes – diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

“…15 Mortality is estimated at 5-30% though these figures appear to correlate very closely with the free interval from traumatic injury to operation and usually result from mediastinitis which affects 50% of patients with thoracic oesophageal rupture. 10 Liang et al 8 report a survival of 80% if the diagnosis is recognised within the first 24 h. The overwhelming sepsis is particularly pronounced due to the lack of oesophageal serosa with exposure of the mediastinum and pleural cavities to the bacterial flora and strongly acidic nature of the gastric juices. 12…”

Subcutaneous Emphysema, Pneumo-Orbita and Pneumomediastinum Following a Facial Trauma Caused by a High-Pressure Car Washer

“…Spontaneous pneumomediastinum is usually seen in healthy young persons as a result of rupture of peripheral pulmonary alveoli due to a sudden increase of intraalveolar pressure after an exaggerated Valsalva maneuver. [3] Similarly, acute asthma attack, [4] strenous cough, [5] vomiting, [6] rapid vaginal birth, [7] barotrauma, [8] and even cocaine and similar drugs [9] have all been reported to cause pneumomediastinum and subcutaneous emphysema by leading to increased alveolar and intrabronchial pressures. [3,10] Traumatic pneumomediastinum, on the other hand, develops as a consequence of external head, neck, and thoracic traumas as well as iatrogenically with invasive medical procedures such as esophagoscopy, bronchoscopy, endotracheal intubation, and tooth extraction.…”