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

Esophageal perforation is a rare but life-threatening complication associated with tracheal intubation, especially after difficult intubation. Esophageal perforation after anesthesia is rare and usually secondary to esophageal instrumentation. Spontaneous esophageal perforation following forceful vomiting (Boerhaave's syndrome) is also extremely rare and has some risk factors. We present a case of perforation of esophagus after cataract surgery under general anesthesia with gentle orotracheal intubation and discuss the possible mechanisms responsible for this unusual disease entity. The patient underwent successful surgical repair and was still alive 4 years after the operation.
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PMID:Esophageal perforation after tracheal intubation, spontaneous or iatrogenic?--a case report. 1274 45

Surgical management of Boerhaave's syndrome remains controversial. If left untreated, this is often a fatal condition. This was a retrospective review of cases operated on by one surgeon between 1981 and 1997. Eleven patients (8 males and 3 females), mean age of 63 years (range, 49-74 years), with Boerhaave's syndrome were treated surgically. A history of vomiting (10/11) and/or chest pain (11/11) was elicited in most cases, but only 3 of 11 cases were diagnosed correctly at presentation. From the onset of symptoms to diagnosis, the median delay was 30 hours (range, 6-1440 hours), and in 8 of 11 cases, the diagnosis was made >24 hours after the onset of symptoms. In all 11 cases, site of rupture was the lower one-third of the esophagus (9 to the left pleural cavity and 2 to the right pleural cavity). All cases were treated surgically after active initial resuscitation. The repair was further augmented by either a diaphragmatic flap (n = 1), bovine pericardial patch (n = 2), or Grillo pleural wrap (n = 8). A feeding jejunostomy was used in every case. Although the mean postoperative intensive care unit stay was only 1.8 days, the mean hospital stay was 37.5 days (range, 15-70 days). There were two hospital deaths (18%). After a mean follow-up of 12.5 years (range, 5-20 years), 7 of 11 patients (63%) are alive and asymptomatic. There was one death that was unrelated to the esophageal surgery. Only one patient reported dysphagia to solid food 5 years following primary esophageal repair. Prompt diagnosis and aggressive surgical management has acceptable in-hospital mortality. This condition is associated with significant morbidity, but the long-term outlook for the survivors is very favorable.
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PMID:Late results of primary esophageal repair for spontaneous rupture of the esophagus (Boerhaave's syndrome). 1508 92

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.
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PMID:[Spontaneous esophageal rupture in three patients]. 1581 Jul 7

We present a 50 years old man who was admitted for severe pain in the chest appeared after vomiting, dyspnoea, cardiovascular collapse. The diagnosis of spontaneous perforation of the esophagus (Boerhaave's syndrome) was confirmed by a radiopaque swallow. We performed a laparotomy, mediastinal drainage, cervical esophagostomy and jejunostomy. Postoperatively, the general state was severe--with high fever, important pleurezia, necessitating pleural drainage, mechanical ventilation for 8 days, parenteral and jejunostomy nutrition. It was possible to close the esophagostomy in the 43rd postoperative day. The patient has been dismissed on the 59th day. Five days later he presented in the ER with severe dyspnoea due to tracheal stenosis--emergency tracheotomy was performed, followed by resection of the stenotic cartilages.
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PMID:[Spontaneous rupture of the esophagus. Case report]. 1583 91

Rarely, biliary-enteric fistula can result in duodenal obstruction or Bouveret's syndrome. Boerhaave's syndrome is a distal esophageal rupture in the setting of severe emesis. This case is the first reported successful management of these clinical scenarios occurring simultaneously and highlights important features in presentation, diagnosis, and surgical treatment.
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PMID:Bouveret meets Boerhaave. 1656 2

Boerhaave's syndrome or spontaneous rupture of the esophagus is a rupture of the esophagus after vomiting. It is rare in children, and to date, 26 children have been reported. We present the case of a 5-year-old boy who presented with dyspnea after vomiting and subcutaneous emphysema. The diagnosis was confirmed with esophagoscopy. The patient was successfully treated with a repair of the rupture and a fundoplication. We review the literature on Boerhaave's syndrome in children.
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PMID:Boerhaave's syndrome in children: a case report and review of the literature. 1695 5

An autopsy was performed on a young adult, who apparently died during his sleep. Mediastinitis was established and empyema was also found in left pleural cavity. The oesophagus examination showed a tear in left side. The lesion occurred in the distal oesophagus and showed the leak communicating freely with the left pleural space. Oesophageal perforation was the source of empyema, resulted from barotrauma to the lower oesophagus during the effort of vomiting. Death caused by septic shock. Boerhaave syndrome is a serious and rapidly fatal spontaneous oesophagus rupture. Forceful ejection of gastric contents in an unrelaxed oesophagus against a closed glottis is the mechanism described. The tear thus produced is vertical. The case report discusses the historical, statistical, pathophysiological, diagnostic and therapeutic aspects of Boerhaave syndrome. The syndrome is a cause of sudden death, which be known by forensic pathologists.
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PMID:Spontaneous oesophageal perforation. 1702 20

In this report, we describe the diagnostic, clinical and therapeutic aspects of a 22-year-old man who was diagnosed with a case of Boerhaave's syndrome (BS) 86 hours after acute onset of chest pain and dyspnea following forceful vomiting due to excessive ingestion of alcohol. Early diagnosis and prompt treatment is critical in BS due to the high mortality rates related to delay in diagnosis. We think the main criterion of prognosis is not only the free interval between diagnosis and treatment but the clinical form. We suggest conservative management, including intrathoracic lavage and close monitoring in patients with late presentation with a distal esophageal tear.
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PMID:Successful conservative management of Boerhaave's syndrome with late presentation. 1712 98

We report the case of a 42-year-old man with Boerhaave's syndrome. His medical history was significant only for a long-standing history of dysphagia. The patient presented to the emergency department with vomiting, followed by severe retrosternal and epigastric pain of sudden onset. An esophagogram showed evidence of free extravasation of contrast from the left posterolateral aspect of the distal esophagus just above the level of the hiatus. A minimally invasive technique was used to repair this injury.
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PMID:Minimally invasive management of Boerhaave's syndrome. 1718 97

Spontaneous pneumomediastinum is an uncommon benign disorder that usually occurs in young men. Because of its clinical features and physiopathologic mechanism, other, more serious disorders that could require urgent treatment, such as Boerhaave's syndrome or spontaneous esophageal rupture, must be ruled out. We report the case of a 19-year-old man with no relevant history, who presented mediastinal emphysema after an episode of repeated vomiting in the context of alcohol abuse. Imaging techniques help to assess esophageal involvement.
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PMID:[Spontaneous pneumomediastinum mimicking Boerhaave's syndrome]. 1719 9


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