title: An autopsy case of spontaneous esophageal perforation (Boerhaave syndrome).
abstract: A 45-year-old male, an alcohol addict with asthma, was found dead in his home, after several days of continued drinking. A forensic autopsy was performed 3days after the discovery of his death in order to specify the cause of death. A longitudinal perforation penetrating all layers of the esophagus measuring 1.8cm was present on the left wall approximately 2.0cm from the gastroesophageal junction. There were 1900mL of greenish to brownish turbid liquid in the left pleural cavity and 150mL of greenish viscous liquid in the stomach. Histopathologically, an infiltration of numerous neutrophils was evident in the submucosa layer, proper muscular layer, and serous membrane of the esophagus, corresponding to the esophageal laceration. The serum C-reactive protein (CRP) concentration was determined to be 3.1mg/dL. The alcohol concentrations were determined to be 1.49mg/g in the right cardiac blood, 1.31mg/g in the left cardiac blood, and 2.48mg/g in urine. Based upon the autopsy and histopathological findings, as well as the biochemical and toxicological analyses, we concluded that the cause of death was respiratory failure by pleural effusion, resulting from spontaneous esophageal perforation. This was the first report of a spontaneous esophageal perforation eventually causing respiratory failure.
authors.affiliation: Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan. Electronic address: k-kaori@med.shimane-u.ac.jp.
authors.forename: Kaori
authors.initials: K
authors.lastname: Kimura-Kataoka
authors.affiliation: Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Fujihara
authors.affiliation: Kurata Clinic, Matsue, Shimane, Japan.
authors.forename: Satsuki
authors.initials: S
authors.lastname: Kurata
authors.affiliation: Department of Emergency and Critical Care Medicine, Shimane University Faculty of Medicine, Izumo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Takinami
authors.affiliation: Department of Public Health, Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Division of Medical Genetics and Biochemistry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Takeshita
mesh_terms: D000437:Alcoholism / Q000150:complications; D001344:Autopsy; D003645:Death, Sudden; D004939:Esophageal Perforation / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous
keywords: Alcoholism; Boerhaave syndrome; Forensic autopsy; Spontaneous esophageal perforation