From the Guidelines
Boerhaave diagnosed spontaneous esophageal rupture, now known as Boerhaave syndrome, which is a life-threatening condition characterized by a large full-thickness tear in the lower third of the distal esophagus, often requiring surgical intervention and having a high mortality rate if left untreated. This condition occurs when the esophagus tears due to sudden increased pressure, typically following forceful vomiting 1. The classic presentation includes severe chest pain, vomiting, and subcutaneous emphysema. Herman Boerhaave first described this condition in 1724 after performing an autopsy on Baron Jan van Wassenaer, who died after a particularly violent episode of vomiting following a large meal.
According to the most recent and highest quality study 1, it is essential to differentiate Boerhaave syndrome from other causes of esophageal perforation, such as eosinophilic esophagitis (EoE), as their treatment and outcomes differ significantly. EoE is now the most common cause of spontaneous perforation of the esophagus, and it can occur at any age from children to adults 1. However, Boerhaave syndrome is a distinct entity that requires prompt recognition and intervention to prevent severe morbidity and mortality.
The diagnosis of Boerhaave syndrome is crucial, and it should be suspected in patients presenting with severe chest pain and a history of forceful vomiting 1. The treatment typically involves surgical repair of the tear, antibiotics to prevent infection, and supportive care 1. Early diagnosis is crucial, as mortality rates increase significantly with delayed treatment 1. In contrast to EoE, which often resolves with conservative treatment, Boerhaave syndrome requires surgical intervention in most cases, and mortality rates are significantly higher if left untreated 1.
Key characteristics of Boerhaave syndrome include:
- A large full-thickness tear in the lower third of the distal esophagus
- Massive contamination of the right thorax
- High mortality rate if left untreated
- Requires surgical intervention in most cases
- Differentiated from EoE, which has a distinct presentation and treatment approach 1.
From the Research
Boerhaave's Diagnosis
Boerhaave diagnosed a condition known as Boerhaave's syndrome, which is a rare yet serious condition associated with high mortality and morbidity 2.
Condition Characteristics
The condition is characterized by:
- Spontaneous rupture of the esophagus, usually in the distal segment 3
- High mortality and morbidity 2, 4
- No specific symptom, making diagnosis difficult 4
- Requires urgent intervention 4
Diagnostic Methods
Diagnosis of Boerhaave's syndrome is usually done with the aid of:
- Imaging, such as HRCT chest or gastrografin study 3
- Clinical correlation along with imaging 3
- Chest computed tomography (CT) scan 4
Treatment Options
Treatment for Boerhaave's syndrome has been mainly surgical since its discovery by Herman Boerhaave 2, but multiple endoscopic approaches have been successfully used recently, including: