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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Boerhaave's syndrome, or spontaneous esophageal perforation, is an infrequent entity with an elevated morbidity and mortality. Its clinical manifestations are such that an extensive differential diagnosis with other entities in necessary, but diagnostic delay worsens the prognosis. We present a new case of Boerhaave's syndrome, that debuted as a picture of acute abdomen which led to the realization of an exploratory laparotomy that failed to evidence the esophageal perforation.
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PMID:[Boerhaave syndrome, as a cause of acute abdomen]. 281 2

A 78-year-old man was admitted to a surgical emergency room because of an acute abdomen. He had vomited violently four times shortly after a meal. This episode was followed by severe upper abdominal and thoracic pain, radiating to the back. Clinical evaluation revealed epigastric peritoneal signs and a soft lower abdomen. Emergency laparotomy disclosed peritoneal adhesions, a distended stomach and numerous diverticula of the small intestine. Neither a perforation nor inflammatory signs were noted. A dramatic accentuation of the pain occurred, followed by the clinical picture of septic-toxic shock. On a chest X-ray, liquid was noted in the left pleural cavity. On occasion of a puncture, this liquid was found to be malodorous and bloody. Cultures yielded Vibrio vulmificus, streptococcus viridans as well as proteus and klebsiella species. The patient succumbed to multiorgan failure on the third day of hospitalization. The autopsy disclosed a recent rupture of the esophagus (Boerhaave syndrome) with purulent peri-esophagitis and mediastinitis as well as fibrinopurulent left-sided pleuritis.
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PMID:[Vomiting, upper abdominal pain and sepsis]. 780 Oct 6

Postemetic spontaneous rupture of the esophagus is an intrathoracic disaster which is generally lethal if untreated. The tragedy seems to strike more often than commonly suspected. The current literature review focuses on publications since 1980 and includes the retrospective review of 18 additional patients treated in our hospital for spontaneous rupture of the esophagus. Frequently, a wide variety of unspecific symptoms has led to the mistaken diagnosis of an acute abdomen, pancreatitis or cardiac arrest. About 40% of the patients with spontaneous rupture of the esophagus presented a history of alcoholism or heavy drinking and 41% suffered from gastroduodenal ulcer disease. Pain (83%) and vomiting (79%) often associated with dyspnea (39%) and shock (32%) are the major symptoms. This unspecific symptomatology delayed the correct diagnosis of the Boerhaave's syndrome and resulted in a significant complication rate. The mortality rate associated with Boerhaave's syndrome was 50% from the first successful surgical repair in 1947 by Barrett to 1980. After 1980, however, the mortality rate dropped to 31%, because of earlier diagnosis, surgical repair and improvement in intensive care. When surgery is delayed, the prognosis of patients with spontaneous rupture of the esophagus is in general severe.
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PMID:Boerhaave's syndrome: analysis of the literature and report of 18 new cases. 907 78