Boerhaave's syndrome presenting as a right-sided pleural effusion.
BACKGROUND
Boerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation.


METHODS
A 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture.


METHODS
The patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed.


RESULTS
The oesophageal rupture was contained but patient died from postoperative complications.


CONCLUSIONS
Physicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.
Yang
S T
ST
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. gm3yty@sgh.com.sg
Devanand
A
A
Tan
K L
KL
Eng
P C
PC
D000368:Aged; D004935:Esophageal Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D010996:Pleural Effusion / Q000209:etiology*; D012422:Rupture, Spontaneous; D014839:Vomiting / Q000150:complications