Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain.We don’t see it often, but it’s a real thing.
Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting.So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind.Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting.
ED management is essentially ABCs and broad spectrum antibiotics, and maybe even antifungals.
As soon as you make this diagnosis, get you CT surgeon on board as the length of time to definitive treatment is directly related to mortality.
I was the Boerhaave Syndrome patient from this podcast which I happy to find by accident.. This occurred 6 years ago today on 8/23/16 – I can’t thank everyone enough at NYU (Especially Dr. Jenny Beck Esmay and Dr Zervos) for saving my life that night and for the care provided weeks after. It was the most humbling experience of my life.