CASE REPORT   

Il Giornale Italiano di Radiologia Medica 2018 Novembre-Dicembre;5(6):763-7

DOI: 10.23736/S2283-8376.18.00134-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: Italian

A case of Boerhaave Syndrome in an alcoholic patient: TC semeiotics

Corradino SAMARELLI ¹ ✉, Mariantonietta FRANCAVILLA ¹, Annarita MILELLA ¹, Caterina CAMPAGNA ², Michele VENDOLA ³, Amato A. STABILE IANORA ¹

¹ Sezione di Diagnostica per Immagini, Dipartimento interdisciplinare di Medicina, Università degli Studi di Bari Aldo Moro, Bari, Italia; ² U.O.C. di Radiodiagnostica Universitaria, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italia; ³ U.O. di Radiologia, ASL BA, Ospedale Umberto I, Corato, Bari, Italia

The Boerhaave Syndrome, or spontaneous rupture of the esophagus, is a rare clinical entity, with an incidence of 1/6000 and a mortality between 10 and 40%. It is more frequently found in people aged between 40 and 60, usually males, (male/female ratio 2:1), with alcohol abuse. The tear is due to a sudden and abrupt distension of the distal esophagus during closed glottis strains, which causes a significant and rapid increase of the endoluminal pressure, often during the vomiting effort. We describe the case of a 42-year-old male patient with a history of potus, duodenal ulcer and reflux esophagitis, who arrived in the emergency room for back pain and vomiting. The patient, after 10 hours from the clinical onset of the symptomatology, underwent CT examination with intravenous injection of contrast medium of chest and abdomen, which showed findings compatible with tearing of the distal esophagus. Subsequently, the patient, after esophageal raffia surgery, repeated a thoraco-abdominal CT scan after administration of oral hydrosoluble iodate contrast medium, which documented the resolution of the picture described. The shortness of the time lapse between the onset of symptoms and the diagnosis achieved with the CT scan, followed by a correct treatment, showed an improvement in the prognosis of Boerhaave Syndrome and avoided serious complications such as acute mediastinitis, pleural empyema and sepsis.

KEY WORDS: Boerhaave syndrome - Alcoholism - Tomography, X-ray computed