CASE REPORT   

Journal of Radiological Review 2021 March;8(1):43-6

DOI: 10.23736/S2723-9284.21.00103-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Boerhaave Syndrome in a young non-drinker man

Luigi BARBUTO ✉, Marco DI SERAFINO, Chiara PAOLELLA, Fabio GIUSTO, Roberto RONZA, Francesca IACOBELLIS, Filomena PEZZULLO, Luigia ROMANO

Department of General and Emergency Radiology, Antonio Cardarelli Hospital, Naples, Italy

Boerhaave Syndrome is a rare but a very serious condition characterized by the spontaneous esophageal rupture. The first description of the spontaneous transmural rupture of the esophagus was in 1724 by Hermann Boerhaave. This condition is typically caused by vomiting after heavy eating and drinking, followed by trauma, medical instrumentation, caustic ingestion and very rare cases of spontaneous rupture. The estimated incidence is about 1:6000 and tends to be more prevalent in males. The typical site of rupture is on the left at a supradiaphragmatic location. The clinical diagnosis in typical cases of Boerhaave Syndrome is based on Mackler’s triad: vomiting, sudden severe chest pain, and subcutaneous emphysema. Dyspnea is frequently observed due to pneumothorax, pleural effusion, or atelectasis. Shock symptoms dominate the clinical picture in 25% of cases. However, in many cases the initial signs are nonspecific, consisting of sepsis, fever, or hypotension and leading to the misdiagnosis as acute aortic dissection, aortic rupture, myocardial infarction, perforated peptic ulcer, pancreatitis, or others. A promptly diagnosis and treatment are important because it is a life-threatening disease. The complications are characterized by enteric leakage into the thoracic or abdominal cavity leading to a consequent sepsis and multisystem organ failure. The mortality rate remains high, between 20% to 40%, often due to severe respiratory failure. In our case report we describe a particular case of a healthy non-drinker young man with distal esophagus rupture.

KEY WORDS: Boerhaave syndrome; Esophageal perforation; Pneumothorax