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Case Reports in Critical Care
Volume 2013, Article ID 161286, 4 pages
http://dx.doi.org/10.1155/2013/161286
Case Report

Boerhaave's Syndrome: Still a Diagnostic and Therapeutic Challenge in the 21st Century

1Department of Internal Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
2Department of Intensive Care, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
3Department of Radiology, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
4Department of Thoracic Surgery, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium

Received 21 April 2013; Accepted 15 May 2013

Academic Editors: M. Egi, P. Kopterides, C. Lazzeri, and C. Mammina

Copyright © 2013 J. Spapen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Boerhaave's syndrome is a rare but potentially fatal condition characterised by a transmural tear of the distal oesophagus induced by a sudden increase in pressure. Diagnosis is challenging as the classic triad of vomiting, abdominal or chest pain, and subcutaneous emphysema is absent in many patients. Management is multidisciplinary and relies on rapid, distinct, and repeated imaging. Treatment has not been standardised and may be conservative, endoscopic, or surgical. We present a typical case which illustrates possible diagnostic pitfalls and the therapeutic conundrum surrounding management of the syndrome. Based on time of presentation and eventual presence of sepsis, a therapeutic algorithm is proposed.