5-Minute Emergency Consult
Boerhaave Syndrome
Boerhaave Syndrome is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Also known as effort rupture of the esophagus
- 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 35%
- 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
ALERT
“Spontaneous” is a misnomer as it usually occurs after emesis
Etiology
Etiology
- Associated with:
- Forceful vomiting and retching (most common)
- Heavy lifting
- Seizures
- Childbirth
- Blunt trauma
- Induced emesis
- Caustic ingestions
- Laughing
- History of Barrett or infectious ulcer
- History of HIV/AIDS
- History of eosinophilic or pill esophagitis
- History of esophageal cancer
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
Description
- Also known as effort rupture of the esophagus
- 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 35%
- 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
ALERT
“Spontaneous” is a misnomer as it usually occurs after emesis
Etiology
Etiology
- Associated with:
- Forceful vomiting and retching (most common)
- Heavy lifting
- Seizures
- Childbirth
- Blunt trauma
- Induced emesis
- Caustic ingestions
- Laughing
- History of Barrett or infectious ulcer
- History of HIV/AIDS
- History of eosinophilic or pill esophagitis
- History of esophageal cancer
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Boerhaave Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307530/all/Boerhaave_Syndrome.
Boerhaave Syndrome. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307530/all/Boerhaave_Syndrome. Accessed March 29, 2023.
Boerhaave Syndrome. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307530/all/Boerhaave_Syndrome
Boerhaave Syndrome [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 March 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307530/all/Boerhaave_Syndrome.
* Article titles in AMA citation format should be in sentence-case
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ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307530/all/Boerhaave_Syndrome
PB - Lippincott Williams & Wilkins
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DB - Emergency Central
DP - Unbound Medicine
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