Boerhaave’s Syndrome
description
Transcript of Boerhaave’s Syndrome
Boerhaave’s Syndrome• "Spontaneous" esophageal
rupture was described by Boerhaave in 1724.– Dutch admiral Baron John von
Wassenauer overindulged on roast duck and wine, subsequently vomited/died
– Autopsy revealed gastric contents in pleural space
– at the time surgery was considered “a fools venture”
Herman Boerhaave1668-1738
• Dutch physician, botanist, chemist, medical educator, philosopher– self taught medicine– attended dissections but not lectures– married daughter of a rich merchant– did lectures for $– treated rich and famous– insisted on autopsies– bedside teaching– did consults by mail– Never had a bad hair day
Boerhaave’s Syndrome• Classic triad
– vomiting, – excruciating chest pain– subcutaneous emphysema
CXR
• Left pleural effusion/ left hydropneumothorax in 12 to 24 hours.
• Pulmonary infiltrates• SubQ air• Widened mediastinum
Boerhaave’s Syndrome• Anatomy
– perf of esophagus -> mediastinum– negative pressure promotes soilage– 90% tears along the left, posterolateral wall of
the distal esophagus– role of esoph. disease is ?
• Etiology– retching against a closed glottis
• also laughing, childbirth, sz, trauma, heavy lifting• most common cause upper endoscopy (~60%)
Causes
• Endoscopy (~60%)• Dilations• NG tubes• Neck/abd Surgery• Post emetic• Infection
• Blunt trauma• Caustics• Foreign body• Esoph disease
Boerhaave’s Syndrome Clinical features -may be delayed!
• Pain, (pleuritic, back, chest, abd)
• Dyspnea• Subq Air/
mediastinal air• Hamman’s
crunch (systolic)
• Vomiting• Dysphagia • Change in voice• Sepsis
Boerhaave’s Syndrome
• Treatment– ABCs– NPO– Antibiotics/fluids– Consultation
• Outcome– survival 65-90%– poor survival w/ delayed dx >48hrs
Boerhaave’s Syndrome• Diagnosis
– often difficult– 1/3 presentations are atypical– Differential dx
• Spont. Mediastinum• Thoracic Aortic Aneurysm• PE• PUD• Pancreatitis• Mesentaric ischemia
Follow up
• Pt underwent thoracotomy, repair• Episode of lidocaine toxicity in the
ICU• Discharged home