28-year-old alcoholic patient walks to hospital with the complaints of binge vomiting, chest pain, fever and X ray shows hydropneumothorax. The most probable condition;
BOERHAAVE Syndrome- Aka Spontaneous esophageal perforation- Caused by* Forceful vomiting* Repeated vomiting- MC site of perforation - Lower 1/3rd of esophagus along Left posterolateral direction- More common in malesClinical features- Characterized by Mackler's triad* Thoracic Pain* Vomiting* Cervical subcutaneous emphysema- In case of massive contamination / inflammation* Fever* SepsisInvestigation- On CXR - Hydropneumothorax- IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque) Management- Depends on Time of Presentation Within 24 hours After 24 hours * Golden period of repair Esophagostomy + ICD inseion + feeding jejunostomy * Repair of Perforation + ICD inseion + Feeding jejunostomy Moality rate upto 20% Moality rate > 50%
Boerhaave syndrome
Tension pneumo thorax
PUD perforation
Mallory Weiss tear
FMGE 2019