Clinical features

The clinical symptoms of Boerhaave's syndrome include:

• characteristically seen in middle aged men (but it can occur at any age and in both sexes) with a history of high alcohol intake, 'retching' and vomiting although up to 45% may have no history of vomiting on presentation (1)
• a history of retrosternal pain progressing to to excruciating epigastric pain that is increased by swallowing
• failure of opiates to relieve pain

Signs of Boerhaave's syndrome include:

• respiratory collapse:
  • dyspnoea
  • cyanosis
  • shock
• subcutaneous emphysema in the neck
• hydrothorax
• pneumothorax (both a hydrothorax and pneumothorax may take some hours to develop)
• pleural effusion
• tenderness over epigastrium and rigidity

Reference

1. van der Weg G, Wikkeling M, van Leeuwen M, Ter Avest E. A rare case of oesophageal rupture: Boerhaave's syndrome. Int J Emerg Med. 2014;7:27.