[Acute upper abdominal pain after excessive vomiting: Boerhaave's syndrome].

BACKGROUND

Boerhaave's syndrome is a spontaneous oesophageal rupture caused by excessive vomiting. Left untreated the mortality rate is high. Surgical intervention was always the treatment of first choice, but increasingly a minimally invasive approach involving the endoscopic placement of an oesophageal stent is being carried out.

CASE STUDY

A 55-year-old man with no previous history presented at the Emergency Department complaining of pain in the upper abdomen that had come on suddenly after excessive vomiting. On CT scan Boerhaave's syndrome was diagnosed. An oesophageal stent was placed. The postoperative course was complicated by mediastinal and pleural abscesses for which surgical debridement was required. After 2 months the patient was discharged to a rehabilitation centre.

CONCLUSION

Surgical intervention is indicated if a patient with Boerhaave's syndrome is haemodynamically unstable or has sepsis, and the diagnosis is made within 24 hours. In all other cases a minimally invasive approach involving antibiotics, pleural drainage and endoscopic stent placement should be considered.