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Case Reports
. 2024 Apr:117:109482.
doi: 10.1016/j.ijscr.2024.109482. Epub 2024 Mar 11.

Septic shock revealing boerhaave's syndrome a case report

A Sebai  1 , R Elaifia  2 , S Atri  1 , M Ben Brahim  1 , A Haddad  1 , J M Kacem  1
Affiliations
Case Reports

Septic shock revealing boerhaave's syndrome a case report

A Sebai et al. Int J Surg Case Rep. 2024 Apr.

Abstract

Introduction and importance: Boerhaave's syndrome, recognized as spontaneous esophageal rupture, is an uncommon and perilous medical condition marked by the spontaneous tearing of the esophagus. This paper highlights the importance of an early diagnosis and its correlation to better outcomes for a rare pathology with high mortality.

Clinical presentation: A 67-year-old female presenting with unexplored vomiting and hypertension, presented to the ER with a septic shock. The patient's clinical deterioration prompted emergency exploration, revealing a dilated esophagus with a 3-cm perforation. Despite surgical intervention, including suturing with a T-tube and esophageal exclusion, the patient succumbed to multiorgan failure.

Clinical discussion: Boerhaave's syndrome, triggered by forceful vomiting, presents diverse clinical manifestations, making accurate diagnosis challenging. The characteristic triad of vomiting, pain, and subcutaneous emphysema is observed in a minority of cases, often overshadowed by acute respiratory distress. Diagnostic modalities include chest X-rays, contrast esophagography, and computed tomography, aiding in visualizing contrast leakage and confirming the diagnosis. The choice of surgical technique, ranging from esophageal suturing to esophagectomy, depends on the duration between rupture and surgery initiation. In this case, a bipolar esophageal exclusion was performed due to the patient's critical condition.

Conclusion: Boerhaave's syndrome demands consideration in patients presenting with thoracic pain and vomiting, particularly in those with a pathological esophagus. Early diagnosis and surgical intervention remain pivotal in improving outcomes. Identification of hydro-pneumothorax in radiographic studies should prompt consideration of spontaneous esophageal rupture, highlighting the need for heightened clinical suspicion in nonspecific clinical scenarios.

Keywords: Boerhaave; Case report; Esophagus; Perforation; Septic shock.

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Conflict of interest statement

Conflict of interest statement All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Chest X-ray revealing an air-fluid level in the right lung.
Fig. 2
Fig. 2
Computed tomography scan showing contrast leakage.
Fig. 3
Fig. 3
Purulent pleural effusion mixed with undigested food.
Fig. 4
Fig. 4
Perforation on the right lateral aspect of the esophagus.
Fig. 5
Fig. 5
Perforation reparation using a T-tube.
See this image and copyright information in PMC

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