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esophageal perforation (Boerhaave syndrome)
Etiology:
1) carcinoma
2) foreign body
3) chemical burns
4) instrumentation
5) severe retching & vomiting
a) alcoholics
b) esophagitis
Pathology:
- rupture of the esophagus resulting from increased esophageal lumenal pressure during vomiting against a closed glottis
- mediastinitis results
- rupture into the left pleural space may occur
Clinical manifestations:
1) Mackler triad
a) vomiting
b) lower chest pain
c) subcutaneous emphysema
2) retrosternal pain with radiation to the back & epigastrium
- abdominal rigidity (intra-abdominal perforation)
3) hematemesis
4) melena
5) fever
6) tachycardia, tachypnea
7) shock
Laboratory:
1) complete blood count (CBC)
2) endoscopy to identify esophageal laceration
3) pleural fluid (thoracentesis)
a) exudate effusion
b) elevated amylase (salivary)
c) pH generally diminished (as low as 7.00)
d) mesothelial cells variable
Radiology:
1) anterior displacement of the trachea
2) pleural effusion
3) pneumothorax
4) mediastinal emphysema (occasional)
Related
Mallory-Weiss tear
General
esophageal disease
gastrointestinal perforation
References
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 884
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998