Thread by @ManualOMedicine

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💠 Boerhaave Syndrome - Key Points

➡️ Boerhaave syndrome is a spontaneous rupture of the esophagus from barotrauma related to retching or any sudden increase in intraabdominal pressure against a closed glottis.

manualofmedicine.com/topics/gastroe…

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➡️ Classically, we associate Boerhaave syndrome with Mackler triad:

👉 retrosternal chest pain
👉 vomiting
👉 subcutaneous emphysema

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➡️ Boerhaave syndrome should be suspected in any patient who presents with retrosternal chest pain, neck pain, or epigastric pain, especially if it began after an episode of severe retching or bearing down against a closed glottis (weight lifting, defecation, childbirth, etc)

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➡️ Contrast esophagram (with Gastrografin) is Gold Standard for diagnosing Boerhaave syndrome.

➡️ Chest CT can often suggest an esophageal perforation through the detection of:
👉 esophageal edema
👉 periesophageal fluid
👉 air in the mediastinal or pleural spaces

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➡️ Many cases, however, are diagnosed incidentally on chest radiographs (Chest X-Ray) that reveal:

👉 mediastinal air
👉 subcutaneous emphysema
👉 pneumothorax
👉 pleural effusion

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➡️ Many will present dehydrated and will require intravenous fluids while remaining NPO (nothing by mouth).

➡️ Broadspectrum intravenous antibiotics should be initiated early including coverage of enteric organisms.

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➡️ Intravenous proton pump inhibitors may also be considered, so as to decrease the severity of chemical mediastinitis and pleuritis.

➡️ Rapid surgical or endoscopic repair is the definitive treatment of Boerhaave syndrome

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