Boerhaave syndrome history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2], Ajay Gade MD[3]], Feham Tariq, MD [4]

The clinical manifestations of Boerhaave syndrome (BHS) depend on the location of the perforation. Boerhaave syndrome often presents with excruciating retrosternal chest pain due to an intrathoracic esophageal perforation. Boerhaave syndrome is classically associated with a history of severe retching and vomiting. However, 25 to 45 percent of patients have no history of vomiting.

The history and symptoms are as follows:^{[1][2][3][4][5]}

• Obtaining history gives important information in making a diagnosis of BHS.
• It provides insight into the cause, precipitating factors, and associated comorbid conditions.
• A complete history will help determine the correct therapy and determining the prognosis.
• The areas of focus should be on onset, duration, and progression of symptoms such as

• The clinical manifestations of Boerhaave syndrome depend on the:
  • Location of the perforation (cervical, intrathoracic, or intra-abdominal),
  • The time since the injury
  • The degree of leakage
• Boerhaave syndrome often presents with excruciating retrosternal chest pain due to an intrathoracic esophageal perforation.
• Boerhaave syndrome is classically associated with a history of severe retching and vomiting, however, 25 to 45 percent of patients have no history of vomiting.
• Soon after the perforation, patients can have:
  • Odynophagia
  • Dyspnea
  • Fever
  • Tachypnea
  • Tachycardia
  • Cyanosis, and hypotension on physical examination.
  • A pleural effusion may also occur.
• Patients with cervical perforations can present with:
  • Neck pain
  • Dysphagia
  • Dysphonia
• Patients with an intra-abdominal perforation have epigastric pain that may radiate to the shoulder causing physicians to confuse an esophageal perforation with a myocardial infarction.
• These patients may also have back pain or present with an acute abdomen.
• Mackler’s triad is only present in 14% of patients which includes:
  • Chest pain
  • Vomiting
  • Subcutaneous emphysema
• It may also be audibly recognized as Hamman’s sign.
• Hamman’s sign is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium in spontaneous mediastinal emphysema produced by the heart beating against air-filled tissues.

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