Boerhaave's syndrome

Complete, transmural laceration of the lower part of oesophagus with exit of the gastric content into the mediastinum in the patient with a pre-existing oesophageal disease. Boerhaave's syndrome is the most severe form of Mallory-Weiss syndrome.

Aetiology: spontaneous (retching, ethyl alcohol) or secondary due to reflux oesophagitis, endoscopy, cardiopulmonary resuscitation, trauma, vagotomy, foreign body, etc.

Symptoms: forceful protracted vomiting with sudden pain in thorax and epigastrium which may radiate to the neck, progressive dyspnea, tachypnea, cyanosis and shock. The X-ray show an abnormal left cardiac border with free fluid within the left hemithorax (pleural effusion).

Five times more common in men than in women. The patient is usually between 50 and 70 years old.

Patients with Boerhaave's syndrome have a pour prognosis, because one third of patients die even when they undergo surgical intervention promptly. In patients who don't undergo medical treatment sepsis and shock are cause of death in first 48 hours (90% of patients) or in next few days (10% of patients).

First described by Herman Boerhaave in 1723. His patient was Baron Jan von Wassenaer, Grand Admiral of the Dutch Fleet and Prefect of Rhineland who vomited after a meal and developed left-sided chest pain and died 18 hours later. At post mortem the following were found: a tear of the left posterior wall of the oesophagus 5 cm above the diaphragm, emphysema, food in the left pleural space.

This description was submitted by Zoran Bojanic, M.D., Serbia.

See also Mallory-Weiss syndrome, or gastrooesophageal laceration-haemorrhage syndrome, under George Kenneth Mallory, American pathologist, born 1900.

• H. Boerhaave:
  Atrocis, nec descripti prius, morbis historia: Secundum medicae artis leges conscripta. Lugduni Batavorum; Ex officine Boutesteniana. 1724.