Spontaneous oesophageal rupture

Blencowe, Natalie S; Strong, Sean; Hollowood, Andrew

doi:10.1136/bmj.f3095

Cited by 32 publications

(21 citation statements)

References 9 publications

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“…Key historical and examination findings pointing towards the diagnosis are chest pain, vomiting and subcutaneous emphysema 1 8. However, this combination (termed ‘Mackler's triad’) is only present in about 14% of cases of oesophageal rupture.…”

Section: Discussionmentioning

confidence: 99%

Oesophageal rupture masquerading as STEMI

2016

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A 67-year-old man presented to the emergency department, with acute onset of chest pain. Based on ECG changes suggestive of ST elevation myocardial infarction (STEMI), he was taken emergently to the cardiac catheterisation laboratory for coronary angiography. There he was found to have only non-obstructive coronary disease. Subsequent physical examination and review of his chest radiograph revealed subcutaneous emphysema, and CT scan revealed a distal oesophageal rupture and pneumomediastinum. After stabilisation in the intensive care unit (ICU), he was taken to the operating room for thoracotomy, chest tube placement and stenting of his oesophagus. He survived the incident and, after several weeks of ICU stay, recovered to a large extent. His case highlights the importance of considering oesophageal rupture in the differential diagnosis for acute onset of chest pain.

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Section: Discussionmentioning

confidence: 99%

Oesophageal rupture masquerading as STEMI

2016

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“…It is a rare condition that is estimated to account for approximately 110 patient admissions per year in the UK 3. A transient rise in intraoesophageal pressure, typically during vomiting, causes a full thickness tear in the oesophagus, usually longitudinal and commonly affecting the left posterolateral wall directly above the gastro-oesophageal junction.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome

et al. 2016

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A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces. A diagnosis of Boerhaave's syndrome was made. The patient was transferred to the intensive care unit but did not survive. This case demonstrates the importance of looking for and treating the rarer reversible causes of cardiac arrest, and of maintaining a high index of suspicion for Boerhaave's syndrome. Despite its rarity, Boerhaave's syndrome is often misdiagnosed on initial presentation, leading to delayed treatment and poor outcomes.

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“…12 The most frequent site of perforation is the left posterolateral aspect of the distal portion situated about 2-3 cm from the gastro-oesophageal junction. 13 Generally patients with BS become extremely unwell very quickly. This is usually due to rapid respiratory compromise or overwhelming septic shock and thus is frequently misdiagnosed as tension pneumothorax, cardiac tamponade, dissecting thoracic aorta and sometimes major upper gastrointestinal haemorrhage if the rupture is associated with haematemesis.…”

Section: Discussionmentioning

confidence: 99%

“…14 The principles of initial management involve preventing further mediastinal contamination, parenteral feeding regimes (usually feeding jejunostomy) and the use of antibacterials. 11,13 Complications are numerous and range from pneumothorax and empyema to failed management and further leaks. 15 Mortality is estimated at 5-30% though these figures appear to correlate very closely with the free interval from traumatic injury to operation and usually result from mediastinitis which affects 50% of patients with thoracic oesophageal rupture.…”

Section: Discussionmentioning

confidence: 99%