Henderson J A, Péloquin A J
Department of Medicine, Ottawa General Hospital, Ontario, Canada.
Am J Med. 1989 May;86(5):559-67. doi: 10.1016/0002-9343(89)90385-9.
Spontaneous perforation of the esophagus (Boerhaave syndrome) is an emergency that requires early diagnosis if death or serious prolonged illness is to be averted. The cases of three patients with spontaneous esophageal perforation simulating other primary diagnoses are described. The respective referral diagnoses were pericarditis, lung abscess, and pancreatitis. Each case was characterized by severe illness, and by delay in diagnosis despite multiple consultations. Two patients died. The literature is reviewed and the causes of delay in diagnosis are analyzed. More than 40 years after the first report of successful surgical repair, spontaneous esophageal perforation is insufficiently considered in diagnostic hypotheses, yet may be confirmed or excluded by simple methods. All clinicians need to be alert to this lethal disease, and to be aware of its frequent atypical presentations.
食管自发性穿孔（博赫哈夫综合征）是一种急症，若要避免死亡或严重的长期疾病，需早期诊断。本文描述了三例模拟其他原发性诊断的食管自发性穿孔病例。各自的转诊诊断分别为心包炎、肺脓肿和胰腺炎。每例病例的特点都是病情严重，且尽管经过多次会诊仍诊断延误。两名患者死亡。本文回顾了相关文献并分析了诊断延误的原因。在成功进行手术修复的首次报告40多年后，诊断假设中对食管自发性穿孔的考虑仍不充分，但可通过简单方法予以证实或排除。所有临床医生都需要警惕这种致命疾病，并了解其常见的非典型表现。
