Boerhaave syndrome. A case report

Ladislau Hecser, Katalin Palfi Siklodi, Gabor Csiki, Maria Flustur Lungu, Harald Jung, Octavian Buda
2011 Romanian Journal of Legal Medicine  
Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a rare, well defined clinical syndrome caused by a longitudinal perforation of the esophagus. This syndrome was first described by Boerhaave in 1724. This severe disease causes high mortality rates and it is difficult to diagnose it not only because it is rare but also because it is frequently confused with other severe clinical conditions. Case presentation: In this report we present a unique case of Boerhaave's syndrome in a
more » ... r-old male patient. In the period October 16-21 2009 he was hospitalized with the diagnosis: septic shock, rupture of esophagus, ARDS. The patient died on October 21, 2009 by cardiac arrest. Conclusion: The rupture of the esophagus is a serious condition and its diagnosis is usually neglected during the initial assessment. Key Words: esophageal disease, spontaneous rupture of esophagus, postoperative death B oerhaave Syndrome, first described in 1724, is a life threatening of non-iatrogenic rupture of the esophagus, and rupture usually occurs in the left postero-lateral wall of the lower third of the esophagus. Herman Boerhaave (1668-1738) first described esophageal rupture and the subsequent mediastinal sepsis based upon his careful clinical and autopsy findings and hundreds of references have since been written about Boerhaave's Syndrome. Boerhaave's first report was the case of Baron Jan Gerrit van Wassenaer Heer van Rosenberg (1672 -1723), Prefect of Rhineland and Grand Admiral of the Dutch Fleet. This figure was a nobleman and war hero at the peak of the Dutch Golden Age who played his role in steering the course of European history. Wassenaer had severe left-sided chest pain after vomiting. He died 18 hours later and autopsy showed a tear in the distal esophagus, emphysema and food in the mediastinum. Boerhaave undertook the autopsy and first described the appearance of the corpse, noting the strange accumulation of fluid in the flanks and the spongy crepitation from air under the skin. When he next opened the thoracic cavity he immediately felt more air and detected the strong odor of duck. With deeper dissection, Boerhaave found a ragged communication between the pleural cavities. Then, at the bottom of the chest, he found his answer: a hole in the baron's esophagus, just above his diaphragm. He could detect no sign of chronic ulceration or inflammation, but a fresh injury resulting in massive contamination of the pleural cavity by food, saliva, and stomach contents. Boerhaave had thus uncovered the first recorded case of an esophageal rupture due to forceful vomiting [1] .
doi:10.4323/rjlm.2011.283 fatcat:7vkapncipzey5acmj7f2ibc6re