In contrast to Mallory-Weiss tears (which are mucosal), Boerhaave syndrome is described by rupture or perforation of the esophagus (through the mucosal and muscular layers).
This rupture is caused through a sudden rise of internal esophageal pressure during vomiting, and can stem from excessive food and alcohol intake, or bulimia. Another common cause of this syndrome is iatrogenic perforation.
Most cases of Boerhaave's syndrome occur at the distal (lower-third) esophagus.
After vomiting, or a procedure, patients may display excruciating retrosternal chest pain, and possibly upper abdominal pain.
In less evident cases, where Boerhaave's is suspected, the caregiver may find that the patient presents with odynophagia, or painful swallowing of liquids and foods.
Though not a very important diagnostic finding, due to its lack of sensitivity, patients with this syndrome can develop subcutaneous emphysema, or crepitus, near the mediastinum.
If there is bleeding from the esophageal rupture, patients may go into hypovolemic shock from blood loss.
This condition is usually a surgical emergency. Due to its high morbidity and mortality, potential for rapid clinical deterioration and fatal outcome without treatment, all patients suspected of having Boerhaave syndrome should have surgical consultation.
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