Boerhaave syndrome is a spontaneous longitudinal perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. It is commonly associated with the consumption of excessive food and/or alcohol or underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett’s or infectious ulcers.

• Boerhaave syndrome is a spontaneous perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. Some situations that can induce Boerhaave syndrome include:^[1]
  • Severe straining
  • Vomiting
  • Seizures
• In Boerhaave syndrome, the spontaneous transmural perforation may be as a result of neuromuscular incoordination resulting in a longitudinal esophageal perforation.^[2]
• The most common anatomical location of the esophageal perforation in Boerhaave syndrome is at the left posterolateral wall of the distal intrathoracic esophagus (the distal third of the esophagus is inherently weaker than the rest of the esophagus) and 2-3 cm before the stomach. However, the esophageal perforation in Boerhaave syndrome can also occur in the cervical or intra-abdominal esophagus.^[3]

• Boerhaave syndrome usually occurs in patients with a normal underlying esophagus while some patients have underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett’s or infectious ulcers.^[4][5]
• Boerhaave syndrome is commonly associated with the consumption of excessive alcohol or over eating, or both. Either of these can induce vomiting.^[6][7]

• In Boerhaave syndrome the gross pathology is based on the underlying condition of esophagus which could be normal, eosinophilic esophagitis, Barrett’s or infectious ulcer.

• In Boerhaave syndrome the microscopic pathology is based on the underlying condition of the esophagus which could be normal, eosinophilic esophagitis, Barrett’s or infectious ulcer.