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Boerhaave’s Syndrome

Boerhaave’s Syndrome. "Spontaneous" esophageal rupture was described by Boerhaave in 1724. Dutch admiral Baron John von Wassenauer overindulged on roast duck and wine, subsequently vomited/died Autopsy revealed gastric contents in pleural space

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Boerhaave’s Syndrome

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  1. Boerhaave’s Syndrome • "Spontaneous" esophageal rupture was described by Boerhaave in 1724. • Dutch admiral Baron John von Wassenauer overindulged on roast duck and wine, subsequently vomited/died • Autopsy revealed gastric contents in pleural space • at the time surgery was considered “a fools venture”

  2. Herman Boerhaave1668-1738 • Dutch physician, botanist, chemist, medical educator, philosopher • self taught medicine • attended dissections but not lectures • married daughter of a rich merchant • did lectures for $ • treated rich and famous • insisted on autopsies • bedside teaching • did consults by mail • Never had a bad hair day

  3. Boerhaave’s Syndrome • Classic triad • vomiting, • excruciating chest pain • subcutaneous emphysema

  4. CXR • Left pleural effusion/ left hydropneumothorax in 12 to 24 hours. • Pulmonary infiltrates • SubQ air • Widened mediastinum

  5. Boerhaave’s Syndrome • Anatomy • perf of esophagus -> mediastinum • negative pressure promotes soilage • 90% tears along the left, posterolateral wall of the distal esophagus • role of esoph. disease is ? • Etiology • retching against a closed glottis • also laughing, childbirth, sz, trauma, heavy lifting • most common cause upper endoscopy (~60%)

  6. Endoscopy (~60%) Dilations NG tubes Neck/abd Surgery Post emetic Infection Blunt trauma Caustics Foreign body Esoph disease Causes

  7. Pain, (pleuritic, back, chest, abd) Dyspnea Subq Air/ mediastinal air Hamman’s crunch (systolic) Vomiting Dysphagia Change in voice Sepsis Boerhaave’s Syndrome Clinical features -may be delayed!

  8. Boerhaave’s Syndrome • Treatment • ABCs • NPO • Antibiotics/fluids • Consultation • Outcome • survival 65-90% • poor survival w/ delayed dx >48hrs

  9. Boerhaave’s Syndrome • Diagnosis • often difficult • 1/3 presentations are atypical • Differential dx • Spont. Mediastinum • Thoracic Aortic Aneurysm • PE • PUD • Pancreatitis • Mesentaric ischemia

  10. Follow up • Pt underwent thoracotomy, repair • Episode of lidocaine toxicity in the ICU • Discharged home

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