Hamman and Boerhaave syndromes – diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

Buchanan, Gordon M; Franklin, Vivian

doi:10.1177/0036933014556051

Cited by 14 publications

(14 citation statements)

References 15 publications

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“…While some patients with this complication may tolerate conservative management, others may require surgical intervention. This complication may be suspected in patients presenting with subcutaneous emphysema on physical exam or imaging [25]. …”

Section: Maternal Complicationsmentioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

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Section: Maternal Complicationsmentioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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“…In addition, women with HG also can have excess salivation (Godsey et al, 1991), vitamin B1 and mineral deficiencies (Koch et al, 2003), gastroesophageal reflux symptoms and abnormal liver function tests (Lee et al, 2011). HG is associated with morbidity such as acute kidney injury (Machado et al, 2012), liver dysfunction (Shekhar et al, 2015), pneumomediastinum (Gorbach et al, 1997; Liang et al, 2002), ruptured esophagus (Buchanan et al, 2014), and Wernicke’s encephalopathy (Berdai et al, 2016; Giugale et al, 2015). In addition, a recent case-control study found that psychological distress was a direct consequence of HG (Aksoy et al, 2015), which is in accordance with previous reports of increased risk of cognitive, behavioral, and emotional disorders in this population (Poursharif et al, 2008; Zur, 2013).…”

Section: Hyperemesis Gravidarummentioning

confidence: 99%

Nausea and vomiting of pregnancy - What's new?

Bustos

Venkataramanan²,

Caritis

2017

Autonomic Neuroscience

117

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Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman’s quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.

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“…As such the initial diagnosis is only made in one third of cases [ 6 ]. Boerhaave’s syndrome most commonly presents in older males secondary to excessive alcohol consumption, neurological disease, severe esophageal burns, and scleroderma [ 7 ]. Vomiting is a known predisposing factor in the published case reports of spontaneous esophageal perforations in first trimester, late pregnancy, and postpartum, with only one other case report documenting a spontaneous esophageal rupture in pregnancy in the absence of any vomiting antenatally or intrapartum [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Valsalva maneuver during forced expiration is repeated constantly during pushing causing alveolar barotrauma. Air then travels from the damaged alveoli through sheaths to the mediastinum and into the subcutaneous tissue [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical management is generally required when there has not been an early diagnosis, as patients with esophageal perforation become compromised quickly. It involves drainage of mediastinal or pleural collections, repair of the defect, or stent insertion [ 7 ]. Complications are life-threatening and include tension pneumothorax, further leaks, acute mediastinitis, mediastinal sepsis, and multiple organ failure, all of which can begin to occur within a few hours of injury [ 7 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Pneumomediastinum following a prolonged second stage of labor – an emphasis on early diagnosis and conservative management: a case report

Whelan

Kelly²

2017

J Med Case Reports

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BackgroundEsophageal rupture is an extremely rare condition to occur to a pregnant or postnatal woman. Esophageal ruptures have been previously described in the literature; however, they are most common in the setting of hyperemesis gravidarum.Case presentationThis case report describes a 27-year-old white woman who began complaining of central chest pain and shortness of breath 3 hours after a normal vaginal delivery, with no history of vomiting antenatally or intrapartum. A chest X-ray and computed tomography pulmonary angiogram confirmed surgical emphysema and pneumomediastinum, and a diagnosis of esophageal rupture was made based on these findings. She was stable and conservative management was initiated; she improved over 4 days. Resolution of surgical emphysema was demonstrated on serial chest X-rays without requiring contrast swallow or surgical intervention.ConclusionsThis case exemplifies the importance of a timely diagnosis of esophageal rupture in ensuring a positive outcome for the patient. Delay in diagnosis can lead to an increase in morbidity and mortality.

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Hamman and Boerhaave syndromes – diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

Cited by 14 publications

References 15 publications

Hyperemesis Gravidarum: A Review of Recent Literature

Hyperemesis Gravidarum: A Review of Recent Literature

Nausea and vomiting of pregnancy - What's new?

Pneumomediastinum following a prolonged second stage of labor – an emphasis on early diagnosis and conservative management: a case report

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