Boerhaave's syndrome

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LogoKeyPointsBox.pngMackler's Triad
  • vomiting
  • lower thoracic pain
  • subcutaneous emphysema.

Spontaneous transmural rupture of the lower oesophagus, usually as a result of forceful vomiting. Rupture of the oesophagus allows gastric content to enter the mediastinum and pleural spaces, which may lead to surgical emphysema, empyema and over-whelming sepsis. Mackler's triad describes the vomiting, lower thoracic pain and subcutaneous emphysema but the triad can happen without oesophageal perforation[1]

Mortality is high. Surgical repair in most cases. Endoscopic treatment using covered, self-expanding stents has been employed successfully in several cases[2][3] although late aorto-oesophageal fistula has been described.[4]

First described in 1724, the diagnosis having been observed in 1723 at the post-mortem of Baron Jan von Wassenaar, the Grand Admiral of the Dutch naval fleet.


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