Case reportBoerhaave's syndrome in children: a case report and review of the literature
Section snippets
Case report
A 5-year-old boy underwent a partial removal of medulloblastoma. During operation, there were no complications, in particular, no accidental esophageal intubation. Postoperatively, the boy was nauseous and he vomited. A week after the operation, he became dyspneic, and there was a subcutaneous emphysema in his neck and over his chest, which progressed to the upper arms and abdomen. Breath sounds over the right thorax were decreased; the abdomen was tender at palpation. The chest x-ray showed a
Discussion
Boerhaave's syndrome is usually seen in men between 40 and 60 years of age [2]. The classic clinical presentation consists of a history of alcoholism or excessive eating; Meckler's triade of vomiting, pain in the lower thorax, and subcutaneous emphysema; and typical chest x-ray findings, such as pneumomediastinum and hydropneumothorax. Also, other symptoms such as polydipsia, facial and cervical swelling, pericarditis, pneumopericardium, and pneumoperitoneum may be present.
Boerhaave's syndrome
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Cited by (19)
Iatrogenic mediastinitis in bronchiolitis: Importance of avoiding pharyngeal aspiration
2019, Archives de PediatrieCitation Excerpt :Iatrogenic causes are mainly represented, including Bougie dilatation, endoscopic instrumentation, endotracheal intubation, the respiratory suction catheter and nasogastric tube insertion [1]. Spontaneous esophageal rupture, called Boerhaave's syndrome, is rare and caused by a sudden rise of intra-abdominal pressure, in case of vomiting [2]. According to clinical presentation, operative findings, pathogenesis, and acts performed during hospitalization, respiratory suction catheters (used since arrival at the emergency department) or nasogastric tube insertions (used in the inpatient unit, 12 h before the diagnosis of mediastinitis) were suspected.
The implications of pneumomediastinum and subcutaneous emphysema for the paediatric otolaryngologist
2017, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :The proposed mechanism of injury in SPM is air leak due to alveolar rupture rather than oesophageal or tracheal perforation. Rupture of the oesophagus is exceedingly rare in children [25]. A recent retrospective study performed by Richer & Sanchez examined a group of patients with varying causes of pneumomediastinum [24].
Are esophagrams indicated in pediatric patients with spontaneous pneumomediastinum?
2016, Journal of Pediatric SurgeryCitation Excerpt :In addition, effort rupture of the esophagus, or Boerhaave's syndrome, is rare in children. Antonis et al. [4] reviewed the 26 cases of pediatric Boerhaave's reported in the literature: of these, 58% of cases occurred in the neonatal period, and 65% were associated with pneumothorax, pleural effusions, or hydropneumothorax, often with a tension component. Engum et al. [5] reported on 25 pediatric patients with proven esophageal perforation: 68% were because of iatrogenic injury, 24% were post traumatic, and in 8% the cause was uncertain.
Management of spontaneous pneumomediastinum in children
2015, Journal of Pediatric SurgeryCitation Excerpt :The final entity that should be considered is esophageal rupture. A literature review by Antonis in 2006 showed that Boerhaave’s syndrome is exceedingly rare in children, reported only 11 times outside of the neonatal age group, many cases in association with serious concurrent illness such as malignancy [17]. Though esophageal disruption was seen neither in our study nor in any of the other pediatric series of pneumomediastinum that we reviewed, if a patient’s history warrants, an esophagram in the ER would be appropriate [5,7,10,18].
Esophageal Rupture and Perforation
2012, Pediatric Surgery, 2-Volume Set: Expert Consult - Online and PrintEsophageal Rupture and Perforation
2012, Pediatric Surgery