Abstract

Boerhaave’s syndrome (BS) or spontaneous esophageal rupture is rare in children. It is thought to result from a sudden increase in the intraesophageal pressure during retching combined with negative intrathoracic pressureClassically BS presents with vomiting, subcutaneous emphysema and thoaco-abdominal pain (Mackler’s triad).We reported a 14 year old girl who was previously well presented to a Tertiary Care Centre Emergency Department with a 24 hour history of retrosternal chest pain and upper abdominal discomfort following three days of frequent retching and intense vomiting.

She was in moderate pain and afebrile; heart rate was 100 per minute with respiratory rate 24 per minute. Palpation of both suprascapular fossae and her left axillary fossa revealed crepitus indicating the presence of subcutaneous emphysema. Auscultation of cardiorespitaory system was normal and her. Abdomen revealed mild epigastric tenderness with no rebound phenomenon, masses or organomegally.

Her chest x ray revealed evidence of subcutaneous emphysema and mediastinal air, an upper GI study with water soluble contrast showed extravasation of the contrast from the distal segment of the esophagus into the mediastinum compatible with the diagnosis of spontaneous esophageal rupture or Boerhaave’s syndrome. She was admitted and treated conservatively with intravenous fluids, antibiotics and nil per os with resolution of her symptoms in 48hours and resolution of mediatinal air in-72 hours. Subsequent endoscopy was grossly and histologically normal.