Boerhaave's syndrome presenting as a right-sided pleural effusion

Abstract

Introduction: Boerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation.

Clinical picture: A 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture.

Treatment: The patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed.

Outcome: The oesophageal rupture was contained but patient died from postoperative complications.

Conclusions: Physicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.