Rahman Ali, Alqaisi Sura, Downing Chad
Internal Medicine, Northwell Health at Mather Hospital, Port Jefferson, USA.
Radiology, Stony Brook University, Port Jefferson, USA.
Cureus. 2021 Aug 21;13(8):e17348. doi: 10.7759/cureus.17348. eCollection 2021 Aug.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a severe respiratory syndrome. It started as an epidemic in Wuhan, China, and then become a global pandemic. COVID-19 usually presents with respiratory symptoms, including cough and shortness of breath, accompanied by fever. However, gastrointestinal symptoms, such as nausea, vomiting, and abdominal pain, have also been reported as a less common presentation of COVID-19. Boerhaave syndrome is a transmural perforation of the esophagus that typically occurs after forceful emesis, which should be differentiated from Mallory-Weiss syndrome, a nontransmural esophageal tear. Diagnosis of Boerhaave syndrome can be difficult because of the classic symptoms, resulting in a delay in seeking medical care. Boerhaave syndrome is sporadic, with an incidence of 3.1 per 1,000,000 per year. We present an interesting case of a 53-year-old man who presented to the emergency department (ED) complaining of significant right-sided chest pain and diffused abdominal pain after several episodes of coughing and vomiting associated with shortness of breath and fever for two weeks. The patient was found to have COVID- 19 infection. The patient then had a chest CT without contrast, and an esophagogram was performed, which was consistent with esophageal rupture. The patient had a thoracotomy and surgical repair. This was followed by endoscopy and esophageal stent placement. The COVID-19 pandemic is a major health crisis that has drained medical resources and research capacity. Esophageal rupture is commonly due to iatrogenic causes. Transmural perforation following forceful vomiting has been termed Boerhaave syndrome. Often, it has no specific presentation, which can lead to late diagnosis, delayed treatment, and increased mortality. In this case, the early diagnosis and proper implementation of the general principles of treatment, including sepsis control, drainage, and surgical repair, led to a good outcome for the patient.
2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，是一种严重的呼吸系统综合征。它始于中国武汉的一场疫情，随后成为全球大流行疾病。COVID-19通常表现为呼吸道症状，包括咳嗽和呼吸急促，并伴有发热。然而，恶心、呕吐和腹痛等胃肠道症状也被报告为COVID-19较不常见的表现形式。博雷尔哈夫综合征是一种食管全层穿孔，通常发生在剧烈呕吐之后，应与马洛里-魏斯综合征（一种非全层食管撕裂）相鉴别。由于典型症状，博雷尔哈夫综合征的诊断可能很困难，这会导致就医延迟。博雷尔哈夫综合征为散发性疾病，每年发病率为百万分之3.1。我们报告一例有趣的病例，一名53岁男性因两周来伴有呼吸急促和发热的咳嗽、呕吐发作数次后，到急诊科就诊，主诉右侧胸痛明显和弥漫性腹痛。该患者被发现感染了COVID-19。随后患者进行了胸部非增强CT检查，并进行了食管造影，结果与食管破裂相符。患者接受了开胸手术和手术修复。之后进行了内镜检查和食管支架置入。COVID-19大流行是一场重大的健康危机，耗尽了医疗资源和研究能力。食管破裂通常由医源性原因引起。剧烈呕吐后的全层穿孔被称为博雷尔哈夫综合征。通常，它没有特异性表现，这可能导致诊断延迟、治疗延误和死亡率增加。在本病例中，早期诊断并正确实施包括控制脓毒症、引流和手术修复在内的一般治疗原则，使患者获得了良好的预后。
