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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spontaneous rupture of the esophagus (Boerhaave's syndrome) usually presents in a dramatic fashion. Classically, following repeated episodes of vomiting, patients present with chest pain, dyspnea, cyanosis, shock, and cardiovascular collapse. We present a case of occult Boerhaave's syndrome diagnosed by an upper gastrointestinal series in a 33-year-old man who arrived at the emergency department with a chief complaint of hematemesis. This case report reviews the usual presenting signs and symptoms of Boerhaave's syndrome and concludes with a caution to physicians not to ignore the possibility of this disease entity in relatively stable patients.
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PMID:"Occult" Boerhaave's syndrome. 328 11

A case of asymptomatic pneumomediastinum in a 14-year-old girl with anorexia nervosa and self-induced emesis is reported to emphasize the atypical aspects of this case and the importance of differentiating benign from potentially life-threatening sources of mediastinal air. Individuals who engage in purging behavior are not only at increased risk for both alveolar (primary pneumomediastinum) and esophageal perforation (Boerhaave syndrome) but may also obscure or delay the diagnosis by denying symptoms and/or previous emesis. Because esophageal perforation is serious, the presence of free mediastinal air in a patient with a known or suspected history of emesis should provoke prompt radiographic evaluation of the upper gastrointestinal tract.
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PMID:Mediastinal emphysema in an adolescent with anorexia nervosa and self-induced emesis. 333 79

It is reported on 2 patients with spontaneous perforation of the oesophagus (Boerhaave's syndrome). The picture of the disease is rare. Possible causes, symptomatology, diagnosis, differential diagnosis and therapy are described. Severe thoracic pains, which in most cases appear after vomiting, are in the foreground. Evident for the disease is the escape of the contrast medium in esophagography. The lethality is 30%. Prerequisite for better results of the treatment is a rapid diagnosis and early surgical approach.
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PMID:[Spontaneous perforation of the esophagus (Boerhaave syndrome)]. 343 50

Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.
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PMID:[Spontaneous rupture of the esophagus]. 372 88

Boerhaave's syndrome represents a diagnostic dilemma for the emergency physician. The prognosis of this truly life-threatening emergency is darkened by any significant diagnostic delay. Unfortunately, classic or expected symptoms and signs are frequently absent at presentation, a circumstance that leads to frequent misdiagnosis. Two cases of Boerhaave's syndrome with "atypical" clinical presentations are reviewed and discussed. It is clear that Boerhaave's syndrome should always be suspected in the evaluation of any sudden chest, abdominal, or back pain associated with emesis. However, emphasis should be placed on the fact that this entity may occur without emesis. The chest radiograph is the most helpful diagnostic aid. Undoubtedly, maintenance of a high degree of suspicion by the emergency physician for Boerhaave's syndrome will lead consistently to earlier diagnosis, and subsequent aggressive intervention should result in considerable reduction in rates of both morbidity and mortality.
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PMID:Boerhaave's syndrome: an elusive diagnosis. 377 99

It is apparent from this discussion that it may be exceedingly difficult to make the diagnosis of Boerhaave's syndrome. The failure to correctly diagnose this patient was due, in part, to the absence of vomiting in the history. Nevertheless, the presence of pneumomediastinum on the initial chest roentgenogram was a significant finding that was missed and would have suggested this diagnosis. This patient is an example of an "atypical" presentation and demonstrates that vomiting need not be a part of the presentation. Because esophageal rupture is a rare clinical entity, a high index of suspicion and careful examination of the chest roentgenogram are mandatory to establish the correct diagnosis.
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PMID:Chest pain, shock, and pneumomediastinum in a previously healthy 56-year-old man. 381 74

Belching and severe vomiting may lead in association with gastro-oesophageal prolapse to a variety of lesions within the gastro-oesophageal junction. Incarceration of the prolapse, diffuse hemorrhage from the prolapsed mucosa, longitudinal lacerations (Mallory-Weiss syndrome), intramural hematoma and spontaneous rupture (Boerhaave syndrome) are the most common complications. Based on 4 cases of incomplete rupture of the oesophagus we would like to draw attention to a disorder with mediastinal emphysema or pneumopericardium following severe vomiting. It is postulated that air escapes from a mucosal tear in the terminal oesophagus into the mediastinum. Conservative treatment seems justified.
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PMID:[Incomplete spontaneous esophageal rupture - a variant of the Mallory-Weiss and Boerhaave syndrome?]. 688 Mar 17

Current methods to evaluate patients with esophageal disease include barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of radioisotopes has been useful in evaluation of esophageal reflux and the post-treatment of achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to acid in the esophagus include the acid infusion test, the standard acid reflux test, the acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or esophagitis and allows direct visualization of the esophagus. The treatment of reflux esophagitis is discussed. The differential diagnosis of dysphagia may include achalasia, diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs, strictures, and benign or malignant tumors. The evaluation of dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The Mallory-Weiss syndrome or bleeding from the mucosal tears of the gastroesophageal junction and Boerhaave's syndrome, spontaneous esophageal perforation, are two disorders associated with vomiting. The Mallory-Weiss syndrome usually resolves without specific therapy, but a high index of suspicion is required for patients with chest pain after vomiting, as spontaneous perforation necessitates immediate surgery. Most diverticula need no treatment, but the Zenker diverticulum, if symptomatic, should probably be surgically repaired.
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PMID:Evaluation and management of diseases of the esophagus. 703 70

"Spontaneous" rupture of the oesophagus is rare and happens after a marked rapid rise in intraluminal oesophageal pressure (massive vomiting, asthma etc.). As is known from the literature, forceful swallowing alone may produce spontaneous perforation in the case of damage to the mucosa or muscular layer of the oesophagus. Boerhaave's syndrome associated with rare diffuse idiopathic muscular hypertrophy of the lower oesophagus has been described in only three cases in the literature.
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PMID:[Spontaneous perforation of the esophagus (Boerhaave syndrome) in diffuse idiopathic muscular hypertrophy]. 707 11

The Authors report a case of spontaneous rupture of the esophagus in a 66-year-old alcoholic. The symptomatology was characterized essentially by epigastralgie and vomiting culminating in violent retrosternal pain radiating to the back and by shock. X-rays taken an hour after hospitalization showed an increase of pulmonary hypodiaphania with presence of pleural effusion at the left base, cervicothoracic subcutaneous emphysema. Emergency surgery was performed by thoracotomy associated with suture of the esophageal opening with drainage of the supradiaphragmatic and pleural region. However, the patient died on the 10th day of broncopulmonary complications. The Authors therefore believe that the triad pain, shock and mediastinal thoracico-cervical emphysema should be considered pathognomonical of Boerhaave's syndrome and thus be kept in mind by the surgeon employed in a Division of Emergency Surgery and First Aid.
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PMID:[Boerhaave's syndrome. Emergency surgery]. 720 39


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