Boerhaave’s syndrome in a patient with an upside down stomach: A case report

Saito, Shin; Hosoya, Yoshinori; Kurashina, Kentaro; Matsumoto, Shiro; Kanamaru, Rihito; Ui, Takashi; Higashi, Hidenori; Kitayama, Joji; Lefor, Alan Kawarai; Sata, Naohiro

doi:10.1016/j.ijscr.2015.12.016

Cited by 4 publications

(7 citation statements)

References 16 publications

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“…1,7,8 Boerhaave syndrome is thought to be caused by a sudden increase in intraesophageal pressure leading to a transmural tear through the esophageal tissue. 4 Although it is important to maintain a comprehensive differential diagnosis, physicians must have a high suspicion for this condition as it is frequently misdiagnosed as perforated ulcers, myocardial infarction, or pulmonary emboli. 4 This condition is an essential diagnosis for emergency physicians due to a mortality rate reaching as high as 44%.…”

Section: Discussionmentioning

confidence: 99%

“…4 Although it is important to maintain a comprehensive differential diagnosis, physicians must have a high suspicion for this condition as it is frequently misdiagnosed as perforated ulcers, myocardial infarction, or pulmonary emboli. 4 This condition is an essential diagnosis for emergency physicians due to a mortality rate reaching as high as 44%. Risk factors for developing spontaneous esophageal rupture include male gender and alcohol abuse.…”

Section: Discussionmentioning

confidence: 99%

“…3 This combination of pathology-Boerhaave syndrome in the setting of an upside-down stomach-has only been described once previously in the surgical literature. 4 Each condition can individually lead to significant morbidity and mortality. Upside-down stomach has a high documented risk of incarceration, can lead to esophageal outlet obstruction and perforation, and has previously been suggested as a contributing factor to the development of spontaneous esophageal rupture.…”

Section: Introductionmentioning

confidence: 99%

“…Upside-down stomach has a high documented risk of incarceration, can lead to esophageal outlet obstruction and perforation, and has previously been suggested as a contributing factor to the development of spontaneous esophageal rupture. 4,5 Boerhaave syndrome, if not urgently diagnosed and treated, can rapidly lead to mediastinitis and septic shock with a mortality rate of up to 44%. 6 Volume 8, No.…”

Section: Introductionmentioning

confidence: 99%

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A Critical Combination of Esophageal Rupture and Upside-down Stomach: A Case Report

Tipton,

Schroder

2024

Clinical Practice and Cases in Emergency Medicine

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Introduction: Spontaneous esophageal rupture, or Boerhaave syndrome, and upside-down stomach are rare pathologies associated with grave sequelae. Boerhaave syndrome can have a mortality rate as high as 44%. Upside-down stomach accounts for less than 5% of hiatal hernias and can lead to incarceration and volvulus. Case Report: An 80-year-old woman presented to the emergency department with sudden onset, severe epigastric pain. Physical examination revealed normal vital signs with mild epigastric tenderness. Imaging obtained revealed a large hiatal hernia and ﬁndings concerning for esophageal perforation. The patient was started on 3.375 grams of intravenous piperacillin/tazobactam, and transfer to a tertiary care facility was initiated. After transfer, esophagography conﬁrmed a perforation near the gastroesophageal junction and ﬁndings consistent with an upside-down stomach. The patient underwent successful repair of the esophageal perforation and gastropexy followed by intensive care unit admission and ultimately discharge. Conclusion: Boerhaave syndrome and upside-down stomach are two conditions with high associated morbidity and mortality requiring prompt intervention. Information obtained in the history and physical examination including acute onset of chest pain after vomiting, tachypnea, subcutaneous emphysema, and hypoxia can assist in the diagnosis of the described pathologies. These signs and symptoms can be subtle on examination but are important in raising clinical suspicion for an otherwise rare etiology for acute onset chest pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Critical Combination of Esophageal Rupture and Upside-down Stomach: A Case Report

Tipton,

Schroder

2024

Clinical Practice and Cases in Emergency Medicine

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“…Este es el segundo caso descrito en la literatura, siendo el primero el descrito por Siato y col 9 . Tanto el síndrome de Boerhaave como la volvulación gástrica aguda pueden requerir un tratamiento quirúrgico urgente.…”

Section: Figuraunclassified