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

Boerhaave's syndrome is a transmural rupture of the oesopahgus. It is a rarer, and less well described complication of forceful emesis. The more common complication being a non-transmural Mallory-Weiss tear. Boerhaave's is the most lethal perforation of the GI tract and has a mortality rate between 10 and 50%. It most commonly occurs after indulgence in food or alcohol, particularly in males aged 50-70 years. The well described presentation is of a middle aged man with a sudden onset of severe chest pain in the lower thorax/upper abdomen following repeated retching or vomiting induced by excessive dietary and alcohol intake. However, atypical presentations are common. Presented here is the case of a 26-year-old man who attended accident and emergency department complaining of chest pain. Initial examination was normal. He was subsequently diagnosed with Boerhaave's syndrome. This case highlights the varied presentation of this potentially fatal condition.
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PMID:Walked in with Boerhaave's.... 1738 70

Post-emetic spontaneous rupture of the esophagus (Boerhaave's syndrome) is still a life-threatening condition, despite recent advances in thoracic surgery and critical care medicine. Because a case report on anesthetic management of this condition is rare, we report here successful management of a 46-yr-old man with spontaneous esophageal rupture following forceful vomiting. He suddenly developed severe back pain and acute respiratory distress after vomiting during dinner and was brought to our emergency department. Examination on admission revealed an increased respiratory rate of 20 min(-1) with SpO2 97% with a facemask (O2, 3 l x min(-1)), a pulse rate of 100 min(-1), and a blood pressure of 138/88 mmHg. Upper gastrointestinal endoscopy showed a foreign body and CT examination revealed subcutaneous emphysema. He was diagnosed as spontaneous rupture of the esophagus. Emergency T-tube drainage was therefore scheduled. After semi-awake intubation with midazolam, general anesthesia was maintained with O2 (50%), N2O, sevoflurane (2%), and vecuronium infusion. A bronchial blocker was used for one lung ventilation to facilitate thoraco-abdominal approach. A careful attention should be paid to tracheal intubation to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. A transmural tear in the anterior wall of the esophagus was found and the foreign body (boiled meat) was removed. The patient recovered uneventfully and could be extubated on the first day in the ICU. It should be noted that successful management of this disease depends on accurate diagnosis and appropriate choice of treatments.
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PMID:[Anesthetic management of a patient with post-emetic rupture of the esophagus induced by a foreign body]. 1744 50

Spontaneous esophageal rupture (Boerhaave syndrome) is uncommon in children. Delayed or missed diagnosis can lead to poor outcomes in terms of morbidity and mortality. To highlight the importance of early recognition and management of spontaneous esophageal rupture in children, we report a case of a 16-year-old boy who presented in the emergency department with acute chest pain after episodes of vomiting.
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PMID:Boerhaave syndrome--unusual cause of chest pain. 1766 35

Boerhaave syndrome is a rare disease with a mortality rate that varies from 10 to 40%. The typical clinical presentation (vomiting, pain, subcutaneuous emphysema) is relatively infrequent. In the case of atypical clinical presentation CT scan with contrast medium administered per os is fundamental for diagnosis. Though there is no general consensus on therapeutic strategies, prognosis is dependent on time interval between onset and diagnosis. We observed four patients with Boerhaave syndrome with an atypical presentation. The time lapse between acute event and diagnosis was less than 6 hours in two cases, 24 hours in one case and 72 hours in the last. All patients presented abdominal pain at admission, preceeded by vomiting in two cases. In all cases diagnosis was carried out by CT scan. All patients were treated surgically: in one case raffia alone was performed, in two cases raffia was associated with temporal bipolar oesophageal exclusion, one case went through oesophageal resection with delayed reconstruction of digestive continuity. One patient with severe COBP died from post-surgical sepsis. One fistula after cervical recanalisation and another after raffia of the oesophageal lesion were successfully treated with endoscopy. We suggest that an aggressive surgical approach is the best treatment for this rare and often severe disease.
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PMID:[The Boerhaave syndrome. Personal experience]. 1772 95

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate. We report a case of perforation of the distal oesophagus. A 40-year-old male patient presented at the emergency department with a classic history of acute epigastric pain and dyspnoea after an episode of vomiting. On clinical examination we found a firm, tender abdomen and cervical subcutaneous emphysema. Boerhaave's syndrome was suspected on a clinical basis and was confirmed by thoraco-abdominal CT scan, showing an apparent pneumomediastinum and fluid at both lung bases. The patient underwent surgical repair of the distal oesophageal tear by laparoscopy. A mediastinal drain was left behind and a feeding gastrostomy was established. After initial improvement, the patient developed fever and dyspnoea. A thoracic CT scan revealed left-sided empyema. A thoracoscopic drainage of pus was performed and antibacterial and antifungal treatment was adapted. The patient recovered well and was discharged from the hospital 34 days after admission.
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PMID:Laparoscopic treatment of Boerhaave's syndrome: a case report and review of the literature. 1796 33

We report on the case of a 15-year-old female who developed a pneumomediastinum after heavy vomiting. A rupture of the esophagus (Boerhaave syndrome) was excluded. In the CT of the chest, air was detected in the mediastinum and in the epidural space (epidural pneumatosis). The patient recovered uneventfully with conservative treatment. Air in the epidural space, associated with spontaneous pneumomediastinum, is an extremely rare condition. The air in the spinal canal arrives by migration through the intervertebral foramina from the posterior mediastinum and neck, where the fascial barrier is missing. Therapy consists of symptomatic, conservative treatment.
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PMID:[Epidural pneumatosis and spontaneous pneumomediastinum: differential diagnosis with respect to the Boerhaave syndrome]. 1827 8

The idiopathic esophageal rupture, Boerhaave syndrome, is very rare disease. Early diagnosis and treatment will produce good clinical course. We experienced a case of Boerhaave syndrome with good clinical prognosis because of the prompt diagnosis and surgical repair by thoracotomy. A 58-year-old man complained sudden chest pain after vomiting. Esophageal rupture was diagnosed by chest computed tomography, and the operation was performed after 5 hours from the onset. The lesion of the esophageal rupture was on the left side of esophagus just above the diaphragm 3 cm in length, which was detected by the combination of thoracoscopy and upper gastrointestinal endoscopy. The postoperative clinical course was uneventful and he discharged from our hospital 17 days after the thoracotomy. Further development of imaging techniques and surgery, such as intraoperative endoscopy and thoracoscopy, are useful for the treatment and diagnosis of Boerhaave syndrome.
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PMID:[Idiopathic esophageal rupture (Boerhaave syndrome)]. 1861 5

A 72-year-old woman with liver cirrhosis developed spontaneous esophageal rupture due to vomiting after meals. The middle thoracic esophagus was perforated, and was, therefore, clipped endoscopically. The patient was found to have mediastinal emphysema on the chest CT image, we diagnosed as Boerhaave syndrome. The esophagus was perforated atypically. The patient was discharged in stable condition by conservative therapy. Endoscopic injection sclerotherapy may have effect that patient has not developed serious condition.
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PMID:[Spontaneous esophageal rupture with liver cirrhosis ruptured atypical location postoperaive endoscopic injection sclerotherapy, and treated endoscopically]. 1919 93

Pneumopericardium is a rare but serious finding. It may indicate severe chest trauma and be associated with tracheobronchial and oesophageal injuries. On the other hand, oesophageal rupture such as Boerhaave's syndrome may also be accompanied by pneumopericardium. A case of spontaneous pneumopericardium and pneumomediastinum after alcohol-induced emesis is reported. Tracheal, bronchial, and oesophageal injury were excluded by radiology and endoscopy. Interstitial lung emphysema is discussed as the pathogenesis.
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PMID:[Pneumopericardium after hyperemesis. Possible result of the Macklin effect]. 1925 34

Boerhaave's syndrome is spontaneous transmural perforation of the esophagus, which occurs most often after forceful vomiting or retching. This commonly occurs in the lower third of the esophagus but spontaneous perforation of the pharynx or cervical esophagus is extremely rare. This case presented a 20-yr-old healthy man with spontaneous pharyngeal perforation after forceful vomiting who had no history of instrumentation, cervical trauma, or having eaten anything sharp. Cervical pain and crepitus were the early symptom and sign of pharyngeal perforation and the rupture was detected on gastrografin swallow and CT examinations. The rupture site was higher than the upper esophageal sphincter, differing from Boerhaave's syndrome. The patient was conservatively managed without significant morbidity and mortality. Although this may resolve without surgical intervention, the pharyngeal rupture should receive early detection and clinical attention for preventing potential morbidity by late diagnosis.
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PMID:Spontaneous Pharyngeal Perforation After Forceful Vomiting: The Difference from Classic Boerhaave's Syndrome. 1943 53


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