BOERHAAVE SYNDROME

CASE REPORT

Abstract

INTRODUCTION: Boerhaave Syndrome (BS) is defined as a spontaneous rupture of the esophagus, a rare but potentially fatal condition with a high morbidity and mortality rate, constituting the most lethal perforation of the gastrointestinal tract. CASE REPORT: Male patient, 49 years old, alcoholic, presents with chest pain that has lasted for five days, triggered by emesis due to alcoholic beverages. He is normotensive, normocardic, afebrile and eupneic. Preserved chest expansion, left thoracic and cervical subcutaneous emphysema, and reduction in ipsilateral breath sounds. Computed tomography of the chest was requested and evidenced soft tissue emphysema in the cervical spaces, pleural effusion on the left and pneumomediastinum. Patient underwent double-mouth cervical esophagostomy, conventional gastrostomy, closed pleural orientation on the left and complementary therapy with endoscopic vacuum. There was good postoperative evolution with esophageal transit remaining during the same hospitalization. DISCUSSION: The diagnosis of BS represents a real challenge, and its treatment, whether surgical or not, must be instituted immediately given the high morbidity and mortality. Although Non-Operative Treatment is reserved for selected patients, there is a tendency to adopt aggressive Operative Treatment for patients with late diagnosis, local or systemic complications. Complementary therapies such as esophageal stent or endoscopic aspirator present promising results with less invasiveness and reduced mortality rate. CONCLUSION: SB should be remembered as a differential diagnosis of chest pain in the emergency department. Despite the scarce case series, early diagnosis and treatment constitute the most relevant prognostic factor.