[Boerhaave syndrome. The differential diagnosis of acute retrosternal pain]

Abstract

A 10-cm-long longitudinal tear in the middle third of the oesophagus--with intact deeper muscle layers--was found endoscopically in a 52-year-old alcoholic man who had developed acute retrosternal pain after severe vomiting. There was a leukocytosis of 16,700/microliters and fever of 38.8 degrees C. Because of the diagnosis of incomplete spontaneous oesophageal rupture (Boerhaave syndrome) he was fed parenterally, a gastric tube was placed, and he received three times daily 2 g ampicillin, twice daily 80 mg gentamicin and 1.2 g cimetidine. The fever disappeared after 24 hours and the leukocytosis regressed after four days. At repeat endoscopy after 16 days the tear had healed completely.