Boerhaave syndrome 2597534 220602041 2008-06-20T17:29:12Z Delldot 476500 refs needed for stats, surprising facts. Ce {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 9168 | ICD10 = {{ICD10|K|22|3|k|20}} | ICD9 = {{ICD9|530.4}} | ICDO = | OMIM = | MedlinePlus = 000231 | eMedicineSubj = med | eMedicineTopic = 233 | MeshID = D004939 | }} '''Boerhaave syndrome''' (also called '''Boerhaave's syndrome'''), or '''Esophageal perforation''', is rupture of the [[esophagus|esophageal]] wall. It is most often caused by excessive [[vomiting]] in [[eating disorders]] such as [[bulimia]] although it may rarely occur in extremely forceful [[cough]]ing or other situations, such as [[Esophageal food bolus obstruction|obstruction by food]]. It can cause [[pneumomediastinum]] and/or [[mediastinitis]] (air or inflammation of the [[mediastinum]]) and [[sepsis]]. This condition was first documented by the 18th-century physician [[Herman Boerhaave]], after whom it is named.<ref>{{WhoNamedIt|synd|2800}}</ref><ref>H. Boerhaave. Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta. Lugduni Batavorum; Ex officine Boutesteniana. 1724. </ref> ==Symptoms== It typically occurs after forceful [[vomiting]]. Boerhaave syndrome is a transmural perforation (full-thickness; a '''hole''') of the [[esophagus]], distinct from [[Mallory-Weiss syndrome]], a nontransmural esophageal '''tear''' also associated with vomiting. Because it is generally associated with vomiting, Boerhaave syndrome usually is not truly spontaneous. However, the term is useful for distinguishing it from [[iatrogenic]] perforation, which accounts for 85–90% of cases of esophageal rupture, typically as a complication of an [[endoscopic]] procedure, feeding tube, or unrelated [[surgery]].{{fact|date=June 2008}} Boerhaave syndrome is often seen as a complication of Bulimia. It is associated with "Mackler's triad".<ref>S. Herman, H. Shanies, H. Singh & M. Warshawsky: "Spontaneous Esophageal Rupture: Boerhaave's Syndrome," pages 177-182. Clinical Pulmonary Medicine 10(3), May 2003 [http://www.clinpulm.com/pt/re/clnpulmed/abstract.00045413-200305000-00007.htm abstract]</ref><ref name="pmid12854388">{{cite journal |author=Yang ST, Devanand A, Tan KL, Eng PC |title=Boerhaave's syndrome presenting as a right-sided pleural effusion |journal=Ann. Acad. Med. Singap. |volume=32 |issue=3 |pages=415–7 |year=2003 |pmid=12854388 |doi=}}</ref> ==Pathophysiology== Esophageal rupture in Boerhaave syndrome is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle (a [[sphincter]] within the esophagus) to relax. The syndrome is commonly associated with the consumption of excessive food and/or alcohol. The most common anatomical location of the tear in Boerhaave syndrome is at left posterolateral wall of the lower third of the esophagus, 2–3 cm before the [[stomach]].<ref name="pmid17263979">{{cite journal |author=Korn O, Oñate JC, López R |title=Anatomy of the Boerhaave syndrome |journal=Surgery |volume=141 |issue=2 |pages=222–8 |year=2007 |pmid=17263979 |doi=10.1016/j.surg.2006.06.034}}</ref> ==Treatment== Untreated Boerhaave's syndrome is uniformly fatal.{{fact|date=June 2008}} Its treatment includes immediate [[antibiotic|antibiotic therapy]] to prevent [[mediastinitis]] and sepsis, surgical repair of the perforation,<ref name="pmid17220586">{{cite journal |author=Matsuda A, Miyashita M, Sasajima K, ''et al'' |title=Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report |journal=Journal of Nippon Medical School &#61; Nihon Ika Daigaku zasshi |volume=73 |issue=6 |pages=341–5 |year=2006 |pmid=17220586 |doi=}}</ref> and if there is significant fluid loss it should be replaced with [[Intravenous therapy|IV fluid therapy]] since oral rehydration is, obviously, not possible. Even with early surgical intervention the risk of death is high. ==Notes== <references/> ==References== * [http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine] * [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] {{Gastroenterology}} [[Category:Surgery]] [[Category:Gastroenterology]] [[de:Boerhaave-Syndrom]] [[es:Síndrome de Boerhaave]] [[fr:Syndrome de Boerhaave]] [[it:Sindrome di Boerhaave]] [[pl:Zespół Boerhaavego]] [[pt:Síndrome de Boerhaave]]