Boerhaave Syndrome

Boerhaave Syndrome is a rare but serious condition involving a tear in the esophagus, the tube that carries food from the mouth to the stomach. This tear usually happens after severe vomiting or retching, causing stomach acid and food to leak into the chest cavity. The main body system affected is the digestive tract, but the condition can quickly impact the respiratory and cardiovascular systems due to inflammation and infection. Symptoms often include severe chest pain, difficulty swallowing, and shortness of breath. Because the esophageal rupture allows bacteria to enter the chest, it can lead to life-threatening infections like mediastinitis. Immediate medical attention is critical to manage this condition.

Boerhaave Syndrome is defined as a spontaneous transmural rupture of the esophagus, typically caused by a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure, often following forceful vomiting. This full-thickness tear most commonly occurs in the distal esophagus, leading to leakage of esophageal contents into the mediastinum and pleural cavity. The condition is a surgical emergency due to the risk of severe mediastinitis, sepsis, and shock. Clinically, it presents with the triad of vomiting, chest pain, and subcutaneous emphysema, although this classic presentation is not always present. Diagnosis and management require rapid recognition to prevent high morbidity and mortality. The syndrome is distinct from Mallory-Weiss tears, which are mucosal lacerations without full-thickness perforation.