A lesson in clinical findings, diagnosis, reassessment and outcome: Boerhaave's syndrome.
A man in his 30s presented with a brief episode of vomiting, acute abdominal pain and subsequent development of shortness of breath. On initial examination and investigation, the clinical impression was of a right-sided pneumothorax, pneumonia and pleural effusion. Early antibiotic treatment and management showed a clinical improvement, with the patient reporting resolution of his symptoms. This episode was short lived, with a further deterioration in his condition and worsening of symptoms. Ensuing examination, imaging and investigations demonstrated an oesophageal leak into the right pleural cavity. Following urgent stabilisation measures and insertion of a chest drain, he underwent successful surgical repair. Boerhaave's syndrome is an emergency situation, requiring quick recognition, diagnosis, aggressive treatment and management to optimise a good outcome.
Department of Anaesthetics/Intensive Care, James Paget University Hospital, Great Yarmouth, UK. Melanie_Keane@hotmail.com
Melanie
M
Keane
T
T
Gowripalann
A
A
Brodbeck
P
P
Bothma
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D004417:Dyspnea / Q000209:etiology; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D011014:Pneumonia / Q000150:complications; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal; D014839:Vomiting / Q000209:etiology; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
D000900:Anti-Bacterial Agents