Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Mar 10;17(3):e80377.
doi: 10.7759/cureus.80377. eCollection 2025 Mar.

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

Girish Bakhshi  1 , Shivangi Tiwari  2 , Aishwarya Dutt  2 , Balakrishna Menon  2 , Bhagyashree Ochiramani  2
Affiliations
Case Reports

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

Girish Bakhshi et al. Cureus. .

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.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Chest radiograph depicting left-sided pleural effusion (yellow arrow) with subcutaneous emphysema (red arrow)
Figure 2
Figure 2. Contrast-enhanced computed tomography of the chest showing the esophageal rupture and leak into the left pleural space and mediastinum
Figure 3
Figure 3. Intraoperative image of a full thickness tear in the thoracic esophagus
Figure 4
Figure 4. Intraoperative image showing the intercostal muscle flap to reinforce the primary repair (black arrow)
Figure 5
Figure 5. Esophagogram showing leak of contrast into the mediastinum on the left side
See this image and copyright information in PMC

References

    1. Intercostal pedicle flap for thoracic oesophageal perforations. Alexander PV, Hollands M, O'Rourke IC, Tait N. Aust N Z J Surg. 1997;67:133–135. - PubMed
    1. Mackler's triad: an evolving case of Boerhaave syndrome in the emergency department. Loftus IA, Umana EE, Scholtz IP, McElwee D. Cureus. 2023;15:0. - PMC - PubMed
    1. CT esophagography for evaluation of esophageal perforation. Norton-Gregory AA, Kulkarni NM, O'Connor SD, Budovec JJ, Zorn AP, Desouches SL. Radiographics. 2021;41:447–461. - PubMed
    1. Primary esophageal repair in Boerhaave's syndrome. Cho S, Jheon S, Ryu KM, Lee EB. Dis Esophagus. 2008;21:660–663. - PubMed
    1. Reinforced primary repair of thoracic esophageal perforation. Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Ann Thorac Surg. 1995;60:245–248. - PubMed

Publication types

LinkOut - more resources