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Subject Area

Clinical Pathology

Article Type

Review

Abstract

Spontaneous esophageal rupture (Boerhaave syndrome) is a rare condition, and many physicians may be unfamiliar with its presentation. A delay in diagnosis and intervention leads to increased morbidity and mortality. We report on a 43-year-old man referred to our facility with a 9-day history of worsening chest pain, respiratory distress, and fever after bouts of retching and vomiting following binge drinking at a party. He presented 8 days earlier at a private hospital, where he underwent a left-sided thoracostomy for empyema thoracis. A computerized tomography of the chest and abdomen was ordered. It indicated a left-sided hydropneumothorax with a collapsed ipsilateral lower lobe, and contrast extravasation into the left pleural space at the distal one-third of the esophagus anterior to the descending thoracic aorta. The diagnosis of Boerhaave syndrome with mediastinitis was confirmed. He was transferred to the ICU and subsequently underwent a left posterior lateral thoracotomy, with esophageal resection performed. Seven days postoperatively, he developed an esophageal leakage, which required an esophageal stent.

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