Boerhaave Syndrome: Symptoms, Causes, Treatment
متلازمة بورهاف: تمزق المريء العفوي
Boerhaave syndrome is a full-thickness esophageal tear, often following forceful vomiting or retching. It is an emergency because leaked contents can contaminate the chest.
What is Boerhaave Syndrome?
It differs from a superficial Mallory-Weiss tear. Absence of vomiting blood or air beneath the skin does not exclude esophageal perforation.
Related reading: A mucosal tear distinct from full-thickness rupture.
Symptoms
Severe chest or upper abdominal pain after vomiting may accompany breathlessness, swallowing difficulty or fever. Deterioration can occur without the complete classic symptom pattern.
Causes
A sudden rise in pressure causes spontaneous rupture. Other causes of esophageal perforation, including procedural injuries, are not all classified as Boerhaave syndrome.
Risk factors
Forceful vomiting or retching raises suspicion, but rupture may occur without an obvious medical history. Age or absence of alcohol use cannot exclude it.
Diagnosis
Emergency assessment uses appropriate imaging, often CT or a contrast swallow selected by the team. Additional investigations must not unnecessarily delay treatment.
Treatment
Hospital care includes circulatory support, antibiotics, drainage and surgical or selected endoscopic closure. The specialist team determines nutritional support and surveillance.
Complications
Leakage can cause mediastinal infection, sepsis, shock or collections around the lungs. Delayed recognition and treatment increase complication risk.
Prevention
Prevention is not guaranteed, but repeated vomiting warrants early assessment. Do not induce further vomiting or attempt to manage severe post-vomiting chest pain at home.
When to see a doctor
Call emergency services for severe chest pain after vomiting, especially with breathlessness or fainting. Avoid eating or drinking until assessed and follow emergency instructions.