Clinical Report: Navigating Diagnostic Difficulties in Boerhaave Syndrome

Overview

Boerhaave syndrome is a rare but life-threatening condition resulting from esophageal perforation, often following severe vomiting. This report discusses the challenges in diagnosis and the roles of CT imaging, endoscopy, and video-assisted thoracoscopic surgery (VATS) in managing the condition.

Background

Boerhaave syndrome is characterized by spontaneous esophageal perforation, typically after intense vomiting, leading to severe complications if not diagnosed and treated promptly. The condition has a low incidence but is associated with high mortality rates when treatment is delayed. Accurate diagnosis is complicated by nonspecific symptoms.

Data Highlights

Case study of a 36-year-old male with Boerhaave syndrome demonstrated the use of contrast-enhanced CT, which revealed bilateral pleural effusions and pneumomediastinum. Emergency VATS was performed, leading to the identification of an esophageal perforation.

Key Findings

• Boerhaave syndrome can lead to severe complications, including mediastinitis and septicemia, if not diagnosed within 24 hours.
• Contrast-enhanced CT is the first-line diagnostic tool, revealing findings such as pneumomediastinum and pleural effusion.
• Endoscopic assessment can provide insights into the perforation's location and severity.
• Video-assisted thoracoscopic surgery (VATS) is used for source control and management of pleural contamination.

Clinical Implications

Healthcare professionals should maintain a high index of suspicion for Boerhaave syndrome in patients presenting with severe chest pain following vomiting. Timely use of CT imaging and a multidisciplinary approach can significantly improve diagnosis and management outcomes.

Conclusion

Boerhaave syndrome requires prompt recognition and intervention to prevent complications. The integration of CT imaging, endoscopy, and VATS aids in diagnosis and treatment.

Related Resources & Content

1. Boerhaave syndrome | BJS | Oxford Academic, 2025 -- A comprehensive review of Boerhaave syndrome and its management.
2. Establishing Consensus: New STS Guidelines Aim to Improve Care for Esophageal Perforation Care | STS, 2026 -- Guidelines for managing esophageal perforations.
3. Treatment of Boerhaave syndrome: experience from a tertiary center - PubMed, 2025 -- Insights from a tertiary center on Boerhaave syndrome management.
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8. Boerhaave syndrome | BJS | Oxford Academic
9. Establishing Consensus: New STS Guidelines Aim to Improve Care for Esophageal Perforation Care | STS
10. Treatment of Boerhaave syndrome: experience from a tertiary center - PubMed