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Boerhaave Syndrome, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Spontaneous esophageal rupture from sudden combined increase in intra-abdominal pressure and negative intrathoracic pressure

    • Causes complete, full-thickness (transmural), longitudinal...

Diagnosis

Signs and Symptoms

History

  • Often no classic symptoms

  • Most common symptoms:

    • Chest or epigastric pain after vomiting/retching

  • Mackler triad:

    • Vomiting/retching

    • Chest pain

    • Subcutaneous emphysema

  • Retroste...

Treatment

Pre-Hospital

  • Airway control must be established if patient unresponsive or airway patency in jeopardy.

  • Establish 2 large-bore intravenous catheters and treat hypotension with 0.9% NS.

  • Avoid opi...

Follow-Up

Disposition

Admission Criteria

All cases of Boerhaave syndrome must be admitted to surgical ICU: 
  • Cervical esophageal perforations may be treated by drainage alone.

  • All thoracic and abdominal pe...

Pearls and Pitfalls

  • Chest radiographs done immediately after injury may be normal.

  • Left pleural space involvement is usually associated with a distal esophageal perforation.

  • Right pleural space involvem...

Additional Reading

  • Brinster  CJ, Singhal  S, Lee  L, et al. Evolving options in the management of esophageal perforation. Ann Thoracic Surg.  2004;77:1475–1483.

  • Katabathina  VS, Restrepo  CS, Mart...

Codes

ICD9

530.4 Perforation of esophagus 

ICD10

K22.3 Perforation of esophagus 

SNOMED

  • 19995004 Spontaneous rupture of esophagus (disorder)

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