Postoperative vomiting causing esophageal rupture after antiemetic use. A case report.
BACKGROUND
Antiemetic medications are commonly used in the postoperative patient. Despite the lack of evidence-based data, these medications have also been increasingly used in the management of postoperative ileus. This practice is dangerous and increases the risk for morbidity and mortality.


METHODS
A 77-year-old woman underwent an uneventful total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient developed abdominal distention and vomiting, which were managed with antiemetic medication. The patient continued to vomit, developed esophageal rupture (Boerhaave's syndrome) and died of sepsis and multiorgan failure.


CONCLUSIONS
Despite no scientific evidence for it, the practice of using antiemetic medications and prokinetic agents in the management of postoperative ileus continues. This places the patient at increased risk for completely preventable morbidity, including aspiration, pneumonia, esophageal perforation, prolonged hospital stay and death.
Komenaka
Ian K
IK
Department of Obstetrics and Gynecology, New York Methodist Hospital, Buckley 6, 506 6th Street, Brooklyn, NY 11215, USA. en03@hotmail.com
Gandhi
Sonal G
SG
deGraft-Johnson
John B
JB
Nguyen
Eric T
ET
Gardezi
Syed Q
SQ
D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use*; D018450:Disease Progression; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000601:surgery*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy; D009102:Multiple Organ Failure; D020250:Postoperative Nausea and Vomiting / Q000150:complications* / Q000188:drug therapy*; D018570:Risk Assessment; D012421:Rupture; D014057:Tomography, X-Ray Computed
D000932:Antiemetics