Boerhaave syndrome: Effort rupture of the esophagus
- George Triadafilopoulos, MD
George Triadafilopoulos, MD
- Clinical Professor of Medicine
- Stanford University School of Medicine
Effort rupture of the esophagus or Boerhaave syndrome is associated with high morbidity and mortality and is fatal in the absence of therapy. The occasionally nonspecific nature of the symptoms may contribute to a delay in diagnosis and a poor outcome .
This topic will review the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of Boerhaave syndrome. The clinical manifestations, diagnosis, and management of traumatic and iatrogenic causes of esophageal perforation are discussed in detail, separately. (See "Overview of esophageal perforation due to blunt or penetrating trauma" and "Surgical management of esophageal perforation" and "Overview of gastrointestinal tract perforation".)
Effort rupture of the esophagus, or Boerhaave syndrome, is a spontaneous perforation of the esophagus that results from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure (eg, severe straining or vomiting).
ETIOLOGY AND PATHOGENESIS
Boerhaave syndrome usually occurs in patients with a normal underlying esophagus. However, a subset of patients with Boerhaave syndrome has underlying eosinophilic esophagitis, medication-induced esophagitis, Barrett's or infectious ulcers. Sudden increase in intraesophageal pressure combined with negative intrathoracic pressure such as that associated with severe straining or vomiting, and less frequently with childbirth, seizure, prolonged coughing or laughing, or weightlifting, results in a longitudinal esophageal perforation [4,5].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ETIOLOGY AND PATHOGENESIS
- CLINICAL FEATURES
- Clinical manifestations
- Laboratory findings
- Thoracic and cervical radiography
- Contrast esophagram
- Computed tomography
- Upper endoscopy
- DIFFERENTIAL DIAGNOSIS
- Initial management
- Subsequent management
- - Medical management
- - Surgery
- - Endoscopic therapy
- EXCLUSION OF UNDERLYING ESOPHAGEAL PATHOLOGY
- SUMMARY AND RECOMMENDATIONS