A Rare but Lethal Emergency: A Case Report on Boerhaave's Syndrome

Abstract

Boerhaave's syndrome is a rare and life-threatening condition characterized by spontaneous esophageal rupture, often precipitated by sudden increases in intra-esophageal pressure, typically following forceful vomiting. The nonspecific nature of its clinical presentation, which may include chest pain, vomiting, and dyspnea, often overlaps with other thoracic or gastrointestinal disorders, making diagnosis challenging. This case report describes a 71-year-old female who presented with acute chest pain following episodes of vomiting. Initial clinical examination revealed tachycardia, tachypnea, and subcutaneous emphysema, raising suspicion of Boerhaave's syndrome. Diagnosis was confirmed through contrast-enhanced computed tomography (CECT), which revealed a 3 cm perforation in the thoracic esophagus with pleural effusion. The patient was managed surgically with emergency thoracotomy, debridement, primary esophageal repair reinforced with an intercostal muscle flap, and the placement of a feeding jejunostomy. This case underscores the importance of early diagnosis, prompt surgical intervention, and multidisciplinary management in mitigating the high mortality associated with Boerhaave's syndrome.

Keywords: boerhaave's syndrome; emergency thoracotomy; increased intraesophageal pressure; multidisciplinary approach; muscle flap repair.

Figure 1. Chest radiograph depicting left-sided pleural effusion (yellow arrow) with subcutaneous emphysema (red arrow)

Figure 2. Contrast-enhanced computed tomography of the chest showing the esophageal rupture and leak into the left pleural space and mediastinum

Figure 3. Intraoperative image of a full thickness tear in the thoracic esophagus

Figure 4. Intraoperative image showing the intercostal muscle flap to reinforce the primary repair (black arrow)

Figure 5. Esophagogram showing leak of contrast into the mediastinum on the left side