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.

Keywords: Boerhaave syndrome; Chest pain; Hematemesis; Mallory–Weiss syndrome; Vomiting.

Fig. 1

Chest X-ray of the lateral view (seated position) on arrival in case 1. Several areas of free-air (arrows) just below the diaphragm are evident

Fig. 2

Contrast-enhanced CT on arrival in case 1 (a, b transverse section; c sagittal section). Free-air (arrows) around the distal esophagus, the lesser curvature of the stomach, and the para-aortic area of the abdomen is observed. Bilateral pleural effusion (arrowheads), and the dilated esophagus and stomach (dotted-line arrows) are also observed

Fig. 3

Upper endoscopy performed 98 days after the first visit in case 1. A scar (arrows) after the suture is observed on the left posterior wall of the distal esophagus 38–41 cm from the incisors

Fig. 4

Plain CT on arrival in case 2 (a transverse section; b sagittal section). Small free-air (arrows) is observed in the mediastinum around both the EGJ and the boundary between the middle and lower thoracic esophagus

Fig. 5

Upper endoscopy performed 9 days after the first visit in case 2. A linear scar (arrows) is observed on the left wall of the distal esophagus, including the EGJ