Boerhaave's syndrome--successful treatment of a late case.

A case of spontaneous rupture of the esophagus (Boerhaave's Syndrome) underwent medical treatment as acute myocardial infarction as initial impression, delay diagnosed 16 days after acute event, and subsequently treated successfully, is presented. Because the patient was critically ill, a conservative management was approached, i.e., NG tube decompression, tube thoracostomy, gastrostomy, broad spectrum antibiotics, TPN to jejunostomy enteral feeding. The patient was salvaged successfully and recovered without complication. The initial unawareness of mediastinal emphysema on chest film resulted in delayed diagnosis.