EP-186 Recurrent Boerhaave's Syndrome

Abstract

Boerhaave's syndrome is a rare clinical entity. It is caused by severe straining, vomiting or prolonged severe coughing, affecting the distal intrathoracic part of oesophagus. The clinical presentation is varied and associated with high mortality if there is a delayed diagnosis. Therefore, the mainstay of treatment is early diagnosis, drainage of intrathoracic collection if indicated and restoration of the oesophagal integrity. The recurrent Boerhaave's syndrome is rare, and only a few cases have been reported in the literature. We present a 27-year-old female diagnosed to have Boerhaave's a year back which was managed conservatively, presented to hospital with sudden onset of epigastric pain radiating to left shoulder and chest associated with multiple episodes of vomiting. Abdominal examination revealed a tender epigastric region with elevated white cells and C-reactive protein. CTTAP showed a recurrent para-oesophageal collection of fluid and gas adjacent to the distal oesophagus at the same site, with no pneumoperitoneum. She was managed conservatively for a week with peripheral nutrition. The CTTAP was repeated with oral contrast, which showed partially improved left para-oesophageal collection, and surrounding inflammatory changes had also partly improved with no leak of contrast. She was hemodynamically stable, clinically well, and tolerated oral feeds, so she was discharged from the hospital. As the recurrent presentation is rare, the treatment should be customised for individuals as per their clinical condition. We emphasis on recognising this condition in both acute and chronic condition, which could be vital in preventing the mortality from this condition.