Management of Boerhaave’s Syndrome

Abstract

Boerhaave’s syndrome or spontaneous oesophageal perforation is characterised by
barogenic oesophageal injury. This leads to contamination of the pleural cavity with enteric
contents and various degrees of injury.1 The syndrome is named after Herman Boerhaave, a
Dutch physician, who first described it in 1724. Incidence of spontaneous rupture amongst all
oesophageal ruptures varies between 15-38%.2,3 Mallory-Weiss tears are assumed to represent
part of the spectrum of the spontaneous perforation, but it is likely that these mucosal injuries
reflect shearing rather than barogenic trauma.4 Spontaneous oesophageal perforations are
associated with the highest mortality amongst all gastrointestinal perforations with an overall
rate of nearly 30%. Early diagnosis and definitive surgical management as soon as possible after
the presentation of symptoms, indisputably within the first 24 hours show the best outcomes. If
treatment is started within 24 hours from the onset of symptoms, mortality rate is observed to
be below 10%; after 24 hours, it is approximately 65% and after 48 hours, it reaches 75%-89%.
If left untreated it rises up to 100%.