Boerhaave Syndrome

Boerhaave Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • Spontaneous esophageal rupture from sudden combined increase in intra-abdominal pressure and negative intrathoracic pressure
    • Causes complete, full-thickness (transmural), longitudinal tear in esophagus
  • Esophagus has no serosal layer (which normally contains collagen and elastic fibers):
    • Results in weak structure vulnerable to perforation and mediastinal contamination
    • Esophageal wall is further weakened by conditions that damage mucosa (i.e., esophagitis is of various causes).
  • Majority of perforations occur at left posterolateral wall of the lower third esophagus.
  • Significant morbidity/mortality (most lethal GI tract perforation):
    • Owing to explosive nature of tear
    • Owing to almost immediate contamination of mediastinum with contents of esophagus
    • Overall mortality can approach 20%
    • Mortality can double if treatment is delayed >24 hr from rupture
    • Cervical rupture associated with the lowest mortality, followed by abdominal and thoracic rupture, respectively


  • Associated with:
    • Forceful vomiting and retching (most common)
    • Heavy lifting
    • Seizures
    • Childbirth
    • Blunt trauma
    • Induced emesis
    • Caustic ingestions
    • Laughing
    • History of Barrett ulcer
    • History of HIV/AIDS
    • History of pill esophagitis
  • Common in middle-aged men
  • Medical procedures cause over 50% of all perforations.

Pediatric Considerations
  • Described in female neonates but rarely seen
  • Consider caustic ingestions

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