Esophageal rupture

Boerhaave syndrome
Boerhaave syndrome
	Axial CT image through the upper chest showing extraluminal air (Pneumomediastinum) surrounding the trachea and esophagus
Specialty	Gastroenterology; General surgery

Esophageal rupture is a rupture of the esophageal wall. Iatrogenic causes account for approximately 56% of esophageal perforations, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery.^[1] The 10% of esophageal perforations caused specifically by vomiting are termed Boerhaave syndrome.^[2]

Spontaneous perforation of the esophagus is most commonly a full-thickness tear in the esophageal wall due to a sudden increase in intraesophageal pressure combined with relatively negative intrathoracic pressure caused by straining or vomiting (effort rupture of the esophagus or Boerhaave's syndrome). Other causes of spontaneous perforation include caustic ingestion, pill esophagitis, Barrett's esophagus, infectious ulcers in patients with AIDS, and following dilation of esophageal strictures.^{[citation needed]}

In most cases of Boerhaave's syndrome, the tear occurs at the left postero-lateral aspect of the distal esophagus and extends for several centimeters. The condition is associated with high morbidity and mortality and is fatal without treatment. The occasionally nonspecific nature of the symptoms may contribute to a delay in diagnosis and a poor outcome. Spontaneous effort rupture of the cervical esophagus, leading to localized cervical perforation, may be more common than previously recognized and has a generally benign course. Pre-existing esophageal disease is not a prerequisite for esophageal perforation, but it contributes to increased mortality.^{[citation needed]}

This condition was first documented by the 18th-century physician Herman Boerhaave, after whom it is named.^[3]^[4] A related condition is Mallory-Weiss syndrome which is only a mucosal tear. A common site of iatrogenic perforation is the cervical esophagus just above the upper sphincter, whereas spontaneous rupture as seen in Boerhaave's syndrome perforation commonly occurs in the lower third of the esophagus.^[5]

^ Marx, John A.; Hockberger, Robert S.; Walls, Ron M.; Adams, James, eds. (2010). Rosen's emergency medicine: concepts and clinical practice. Vol. 1 (7th ed.). St. Louis: Mosby/Elsevier. ISBN 978-0-323-05472-0.^{[page needed]}
^ Boerhaave syndrome at eMedicine
^ synd/2800 at Who Named It?
^ Boerhaave, Herman (1724). Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta [Bitter or the results were registered before the history of the disease. According to the written laws of medicine] (in Latin). Lugduni Batavorum; Ex officine Boutesteniana. OCLC 952706276.^{[page needed]}
^ Bailey & Love, 25th ed., page 1014^{[full citation needed]}

[1] Marx, John A.; Hockberger, Robert S.; Walls, Ron M.; Adams, James, eds. (2010). Rosen's emergency medicine: concepts and clinical practice. Vol. 1 (7th ed.). St. Louis: Mosby/Elsevier. ISBN 978-0-323-05472-0.^{[page needed]}

[ReferenceA-2] Boerhaave syndrome at eMedicine

[3] synd/2800 at Who Named It?

[4] Boerhaave, Herman (1724). Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta [Bitter or the results were registered before the history of the disease. According to the written laws of medicine] (in Latin). Lugduni Batavorum; Ex officine Boutesteniana. OCLC 952706276.^{[page needed]}

[5] Bailey & Love, 25th ed., page 1014^{[full citation needed]}

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Boerhaave syndrome

Axial CT image through the upper chest showing extraluminal air (Pneumomediastinum) surrounding the trachea and esophagus
Specialty	Gastroenterology General surgery