All of the following are true about Boerhave syndrome except –
Correct Answer: It has a lower mortality rate compared to a Mallory Weiss tear
Description: Ans. is 'b' i.e., It has a lower mortality rate compared to a Mallory Weiss tear Boerhaave's syndromeo Boerhaave's syndrome is spontaneous perforation of the esophagus, occuring usually due to severe barotrauma when a person vomits against a closed glottis.o The pressure in the esophagus rapidly increases and the esophagus bursts at its weakest point involving all layers, sending a stream of material into the mediastinum and often the pleural cavity as wello Most common location of perforation is in the left posterolateral aspect 3-5 cm above the gastroesophageal junction. Second most common site of perforation is at the midthoracic esophagus on the right sideo Most cases follow a bout of heavy eating and drinking.o The principal early manifestation is pain felt in the chest and upper abdomen.Diagnosiso A chest xray may show pleural effusion or hydropneumothorax (left pleural cavity is involved in 2/3 of cases) and mediastinal emphysema.o The diagnosis is confirmed by a contrast esophagogram which will demonstrate the extravasation in most of the cases.o Water soluble dye (gastrograffin) is preferred. If no leak seen barium study can followo Chest CT can show mediastinal air and fluid level at the site of perforation.Managemento If it presents within 24 hours then primary closure and external drainage is recommendedo If it presents after 24 hours then resection of the affected segment with a cervical oesophagostomy and closure of the distal stump is recommended.o Mortality is upto 50% (far more than Mallory - Weiss syndrome)
Category:
Surgery
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