Walked in with Boerhaave's...

Boerhaave's syndrome is a transmural rupture of the oesopahgus. It is a rarer, and less well described complication of forceful emesis. The more common complication being a non-transmural Mallory-Weiss tear. Boerhaave's is the most lethal perforation of the GI tract and has a mortality rate between 10 and 50%. It most commonly occurs after indulgence in food or alcohol, particularly in males aged 50-70 years. The well described presentation is of a middle aged man with a sudden onset of severe chest pain in the lower thorax/upper abdomen following repeated retching or vomiting induced by excessive dietary and alcohol intake. However, atypical presentations are common. Presented here is the case of a 26-year-old man who attended accident and emergency department complaining of chest pain. Initial examination was normal. He was subsequently diagnosed with Boerhaave's syndrome. This case highlights the varied presentation of this potentially fatal condition.