The Boerhaave syndrome In medical terminology, denotes one named after a Dutch doctor Tear of the esophagus (Esophagus). This rare disease occurs spontaneously. It comes to one Tear in all layers of the wall of the esophagus, so eventually a Opening in the chest area consists. The spontaneous rupture occurs usually just above the diaphragm. This location of the injury is known as the supra-diaphragm. As root cause comes in in most cases too high pressure in the abdomen in question. At the Vomit or at severe coughing fits A high intra-abdominal pressure builds up, which can be so strong that the tissue of the esophagus cannot withstand this increased pressure.
A prerequisite for the injury is often a existing previous damage to the muscles of the esophagus. The muscles can be influenced by various factors such as a wrong diet or a massive alcohol abuse be impaired. The Boerhaave syndrome is also common in eating disordered patients. This shows with one bulimia, in which the patient often vomits in a targeted manner, a typical damage to the tissue layers. When there is rupture of the esophagus increased risk for the patient one Inflammation in the chest or even a pervasive infection known as sepsis is called to develop.
The Boerhaave Syndrome occurs suddenly and with various symptoms on. Typical of this disease is one sudden onset of pain behind the breastbone (sternum). These symptoms, known as retrosternal complaints, are also Annihilation pain called. The complaints often put him in a very anxious to panic sitiation, because many patients can no longer breathe properly either. You suffer from Shortness of breath (Dyspnea). More symptoms can be Vomit also with Blood be. This is then called Hematemesis designated.
Occasionally also occurs Cutaneous emphysema on. This is a morbid one Accumulation of air in the subcutaneous tissuethat can be detected by deformity of the skin. When you feel the skin you can hear a faint crackling sound, which typically sounds like walking on snow. The injury to the esophagus in some cases represents one acute and possibly threatening situation for the patient, as in some cases also a shock can occur. This goes with Circulatory failure and Drop in blood pressure and should be treated immediately.
Boerhaave's syndrome represents a dangerous and also acutely life-threatening situation for the patient. Immediate intensive medical treatment is required here. Surgery is needed to close the hole in the esophagus. This defect coverage is achieved by opening the chest (Thoracotomy) or the abdomen (laparotomy). This is a major intervention, which is why careful intensive medical monitoring is carried out afterwards. The injury can be sewn or covered with your own tissue. Because the defect in the esophagus allows stomach contents to flow into the chest area, there is a risk that the chest could become inflamed. This dangerous complication is known as sepsis or mediastinitis.
In order to additionally protect the patient from this, he is given a broad spectrum antibiotic as an infusion. The patient is also given pain medication. After the operation, parenteral nutrition is given first.This means that the patient receives food in the form of infusions through an access in the vein or through the gastric tube. This is to prevent the seam from tearing again and the wound can first heal in peace. Later on there is a slow increase in the diet. Treatment should be carried out as soon as possible after the onset of the syndrome, otherwise the patients usually die from the complications a short time later.
Differentiation from the pneumothorax
Boerhaave syndrome can also occur in some cases mistakenly diagnosed as pneumothorax become. So here should be a Pneumothorax respectively. Pneumothorax is a similar spontaneous disease. Through a Pneumothorax, one half of the lung collapses. The patient suffers from acute stabbing pain in the chest and sudden shortness of breath. It follows a Feeling anxious and it is not uncommon for patients to lose consciousness.
The pneumothorax can through an injury or spontaneously occur. in case of an Spontaneous pneumothorax can be the cause similar to Boerhaave's syndrome excessive intra-abdominal pressure be in the abdomen. The treatment should be here too as fast as possible so that the patient can breathe easier again. By Insertion of a drain the air is removed into the gap in the lungs and the collapsed lung can unfold again. In addition, a Defect in the lung membrane sewn up by means of an operation. When the normal pressure in the lungs is restored, the drainage can also be removed again.