Tipton Kay Nicole, Schroder Daniel
UNC Health Southeastern, Department of Emergency Medicine, Lumberton, North Carolina.
Campbell University, School of Medicine, Emergency Medicine Residency, Lumberton, North Carolina.
Clin Pract Cases Emerg Med. 2024 May;8(2):95-98. doi: 10.5811/cpcem.20907.
Spontaneous esophageal rupture, or Boerhaave syndrome, and upside-down stomach are rare pathologies associated with grave sequelae. Boerhaave syndrome can have a mortality rate as high as 44%. Upside-down stomach accounts for less than 5% of hiatal hernias and can lead to incarceration and volvulus.
An 80-year-old woman presented to the emergency department with sudden onset, severe epigastric pain. Physical examination revealed normal vital signs with mild epigastric tenderness. Imaging obtained revealed a large hiatal hernia and findings concerning for esophageal perforation. The patient was started on 3.375 grams of intravenous piperacillin/tazobactam, and transfer to a tertiary care facility was initiated. After transfer, esophagography confirmed a perforation near the gastroesophageal junction and findings consistent with an upside-down stomach. The patient underwent successful repair of the esophageal perforation and gastropexy followed by intensive care unit admission and ultimately discharge.
Boerhaave syndrome and upside-down stomach are two conditions with high associated morbidity and mortality requiring prompt intervention. Information obtained in the history and physical examination including acute onset of chest pain after vomiting, tachypnea, subcutaneous emphysema, and hypoxia can assist in the diagnosis of the described pathologies. These signs and symptoms can be subtle on examination but are important in raising clinical suspicion for an otherwise rare etiology for acute onset chest pain.
自发性食管破裂，即博赫哈夫综合征，以及倒位胃是与严重后遗症相关的罕见病症。博赫哈夫综合征的死亡率可高达44%。倒位胃占食管裂孔疝的比例不到5%，可导致嵌顿和肠扭转。
一名80岁女性因突发严重上腹部疼痛就诊于急诊科。体格检查显示生命体征正常，上腹部有轻度压痛。影像学检查发现一个大的食管裂孔疝以及食管穿孔相关表现。患者开始静脉输注3.375克哌拉西林/他唑巴坦，并开始转至三级医疗机构。转院后，食管造影证实食管胃交界处附近穿孔，且发现符合倒位胃的表现。患者食管穿孔成功修复并行胃固定术，随后入住重症监护病房，最终出院。
博赫哈夫综合征和倒位胃是两种具有高发病率和死亡率的病症，需要及时干预。病史和体格检查中获得的信息，包括呕吐后急性胸痛、呼吸急促、皮下气肿和低氧血症，有助于诊断上述病症。这些体征和症状在检查时可能不明显，但对于提高对急性胸痛罕见病因的临床怀疑很重要。
