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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, or post-emetic rupture of the oesophagus, classically presents with vomiting, chest pain and subcutaneous emphysema. Mortality in this condition is very high and increases dramatically with delayed diagnosis and intervention. The vast majority of patients have a tear in the left posterior-lateral wall of the lower third of the oesophagus and require urgent surgical intervention. Spontaneous rupture of the cervical oesophagus is very rare and may present differently to oesophageal perforations elsewhere. A case is presented following vomiting in a 70-year-old woman, which was diagnosed by computed tomography scan and treated conservatively. The attending physician must be alert to the diagnosis of post-emetic cervical oesophageal perforation as prompt diagnosis and treatment is essential to reduce morbidity and mortality.
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PMID:Boerhaave's syndrome: a pain in the neck. 1946 31

We report a case of paediatric Boerhaave's syndrome in 15-year-old girl associated with massive dilatation of the stomach into the pelvis and transient hepatitis of uncertain aetiology. This cluster of clinical finding has not previously been reported. The young girl initially presented with abdominal pain, vomiting and lower urinary tract symptoms. She was initially treated for urinary tract infection after urine dipstick showed leucocytes and nitrates. Later she was found to have the spectrum of findings as described. Patient was treated by restricting to strict no oral intake and gastric decompression. Enteral nutrition maintained via a feeding jejunostomy.Boerhaave's syndrome frequently presents in the context of other emetogenic illnesses which may mimic its features as a result the diagnosis can be difficult. A high index of clinical suspicion is therefore required. We review the literature of paediatric Boerhaave's syndrome to aid the clinician with this diagnostic conundrum.
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PMID:Paediatric Boerhaave's syndrome: a case report and review of the literature. 1991 14

Boerhaave's syndrome, first described in 1724, is a spontaneous transmural perforation of the oesophagus, typically caused by forced emesis. It is classically associated with the 'Mackler triad' of vomiting, lower thoracic pain and subcutaneous emphysema. It is the most lethal perforation of the gastrointestinal tract with an estimated mortality of 20-40% (de Schipper et al, 2009).
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PMID:Boerhaave's syndrome complicating status epilepticus. 2008 46

Boerhaave's syndrome is the rare and often fatal condition of spontaneous esophageal rupture. Meckler's triad of vomiting, pain and subcutaneous emphysema are characteristic features of Boerhaave's syndrome. When these symptoms are absent, diagnosis is frequently late and often occurs as the result of incidental investigation. This contributes to the observed high morbidity and mortality. Unless specifically considered in the differential diagnosis, this rare disease is frequently overlooked. The authors described the case of a patient in whom the diagnosis was made several days following presentation by observing that a large pleural effusion had evolved rapidly on chest radiographs. This uncommon radiological sign has relatively few causes and prompted a review of the history and diagnosis, followed by the initiation of additional investigations that confirmed Boerhaave's syndrome.
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PMID:Boerhaave's syndrome - rapidly evolving pleural effusion; a radiographic clue. 2093 23

An 80-year-old woman was admitted to our hospital with severe chest and back pains after vomiting. Computed tomography (CT) of the chest revealed left-sided pneumothorax and pleural effusion. Some food was drained from an inserted chest tube, and we diagnosed spontaneous esophageal rupture (Boerhaave's syndrome). A left thoracotomy was performed 7 hours after the onset of symptoms. A 3-cm perforation was discovered in the lateral wall of the distal esophagus. The perforation was repaired with a primary two-layered closure and covered with pericardial fat. The patient had a good postoperative course and was discharged 1 month after surgery. This case suggests the importance of early surgical treatment, even in elderly patients with spontaneous esophageal rupture.
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PMID:Successful treatment of a spontaneous esophageal rupture in an elderly patient: a case report. 2120 49

Eosinophilic esophagitis (EoE) has been associated with an increased risk of esophageal mucosal tears induced by vomiting to dislodge impacted food or following endoscopic procedures. However, Boerhaave's syndrome or transmural perforation of the organ resulting from vomiting induced to dislodge impacted food has rarely been reported. In this article, we present two male adult patients with long-term esophageal symptoms who suffered from Boerhaave's syndrome after the impaction of food in the esophagus. Both patients required surgical management because of clinical and radiological signs of perforation. This rare complication of EoE has been documented in 11 other reports, predominantly affecting young men in whom EoE had not been previously diagnosed, despite the majority having esophageal symptoms and a history of atopy. There are only two published cases of esophageal perforation that presented in children, which were managed conservatively. Our two patients and 4 out of the 11 described in literature required surgery because of esophageal perforation. Our two cases involved closure of the perforation, while in three published reports, perforation resulted in a partial or complete esophagectomy. No cases have been published on Boerhaave's syndrome caused by EoE that ended in fatalities. It is important to note that esophageal perforation caused by vomiting is a potentially severe complication of EoE that is being increasingly described in literature. Therefore, patients with non-traumatic Boerhaave's syndrome should be assessed for EoE, especially if they are young men who have a prior history of dysphagia and allergic manifestations.
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PMID:Boerhaave's syndrome as the primary manifestation of adult eosinophilic esophagitis. Two case reports and a review of the literature. 2130 16

Boerhaave syndrome is the spontaneous transmural rupture of the esophagus due to an increase in intraesophageal pressure when vomiting against a closed glottis. There are various methods of managing it, with the main principles of limiting sepsis, draining the area, and maintaining nutrition. These include conservative management, open repair with drain insertion, and laparoscopic repair, depending on the timing of presentation and the amount of sepsis. Although the gold standard is open thoracotomy and/or laparotomy, we present a case where an esophageal rupture, presenting within 24 hours and hemodynamically stable, was managed with laparoscopic repair and drain insertion with good results. There is a paucity of literature regarding this mode of management and we have discussed the various options available in literature. We conclude that this is a safe and viable option in the management of Boerhaave syndrome in a nonseptic patient presenting early.
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PMID:Laparoscopic repair of esophageal perforation due to Boerhaave syndrome. 2185 62

Boerhaave's syndrome is oesophageal rupture as a result of forceful vomiting or retching against a closed cricopharyngeus. We report the case of an 81-year-old man with oesophageal rupture secondary to volvulus of an intrathoracic stomach who underwent laparotomy with a repair of the oesophageal perforation and intrathoracic stomach, making a good recovery. This case demonstrates another life-threatening complication of an intrathoracic stomach and highlights the importance of an early diagnosis and the advantages of using a transabdominal approach in this situation.
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PMID:Boerhaave's syndrome secondary to gastric volvulus. 2255 35

A previously well 18-year-old male presented with a 3-day history of vomiting, abdominal pain and increasing neck swelling. X-rays demonstrated both pneumomediastinum and cervical surgical emphysema and initial efforts were centred upon excluding Boerhaave syndrome (vomiting-induced oesophageal rupture). Upper gastrointestinal endoscopy and contrast CT scans excluded breech of the oesophagus but did, however, confirm dilated small bowel. Over the days, his condition did not improve, repeat CT demonstrated worsening small bowel dilatation and he eventually underwent laparotomy on day 5 of his admission. This revealed a high-grade obstruction in the right iliac fossa (presumably from a previous appendicectomy). Following adhesiolysis, he made a full recovery from both small bowel obstruction and surgical emphysema.
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PMID:Vomiting-induced surgical emphysema and pneumomediastinum: a self-remitting or life-threatening condition? 2270 74

A man in his 30s presented with a brief episode of vomiting, acute abdominal pain and subsequent development of shortness of breath. On initial examination and investigation, the clinical impression was of a right-sided pneumothorax, pneumonia and pleural effusion. Early antibiotic treatment and management showed a clinical improvement, with the patient reporting resolution of his symptoms. This episode was short lived, with a further deterioration in his condition and worsening of symptoms. Ensuing examination, imaging and investigations demonstrated an oesophageal leak into the right pleural cavity. Following urgent stabilisation measures and insertion of a chest drain, he underwent successful surgical repair. Boerhaave's syndrome is an emergency situation, requiring quick recognition, diagnosis, aggressive treatment and management to optimise a good outcome.
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PMID:A lesson in clinical findings, diagnosis, reassessment and outcome: Boerhaave's syndrome. 2272 46


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