Boerhaave Syndrome

Boerhaave syndrome (BS) is a spontaneous esophageal perforation and is a life-threating but uncommon disorder. This syndrome involves a transmural perforation and typically occurs after forceful emesis. The prognosis is dependent on rapid diagnosis and correct management. The classic presentation of BS consists of vomiting, subcutaneous emphysema, and lower thoracic pain. However, significant symptoms and signs rarely occur, about one-third of all patients are clinically atypical. Thus, BS should be suspected in patients presenting any sudden thoracoabdominal pain with a history of emesis. The chest radiograph is the most helpful diagnostic aid, in addition to CT scans for further evaluations.When the clinical condition allows for a less invasive approach, non-operative treatment should be considered, with or without the use of an endoscopic stent or placement of internal or external drains. The best prognosis of Boerhaave's syndrome is associated with early diagnosis and surgical care within 12 hours of perforation.