Boerhaave's syndrome is a spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting. The rupture is usually distally sited and on the left side.

Vs Mallory Weiss tear

Mallory Weiss tears present with vomiting of blood, not perforation.  Boerhaave's syndrome, on the other hand, ruptures the full thickness of the esophagus wall. This is also called a transmural tear.

PC

Patients usually give a history of sudden onset of severe chest pain that may complicate severe vomiting.

• pain worse on swallowing
• minimal/no haematemesis
• signs of shock (tachycardia, hypotension, altered mental status)
• subcutaneous emphysema

Investigations

• CXR: Subcutaneous emphysema may be observed on the chest wall.
• Diagnosis is CT contrast swallow.

The Mackler triad for Boerhaave syndrome: vomiting, thoracic pain, subcutaneous emphysema.

Management

• Intravenous (IV) fluid resuscitation to manage shock
• Administration of IV antibiotics to cover for potential mediastinitis