Boerhaave Syndrome: An Unusual Complication in a Case of Retropharyngeal Abscess

Introduction: Boerhaave's syndrome is a rare entity and it results from increased intraluminal esophageal pressure following sudden forceful vomiting. The most common presentation of BS is a sudden onset retrosternal and/or epigastric pain following vomiting, and CT scan is the investigation of choice. The most common site of perforation is in the posterolateral aspect of the distal esophagus, and surgical intervention is the gold standard approach for treating BS.

Case Detail: A 27-years old male presented with dysphagia and throat pain. 6 hours after the admission, the patient had multiple episodes of vomiting. Videolaryngoscopy revealed posterior pharyngeal wall ulcer. CT scan of neck shows features suggestive of rupture retropharyngeal abscess. After 24 hours patient developed respiratory distress and chest X-ray revealed right side pleural effusion. CT scan confirmed Boerhaave's syndrome and the patient was managed conservatively.

Discussion: If diagnosed within 24 hours surgery carries a 90% success rate but the main concern is the diagnosis and management of late presented cases. Conservative management and adequate drainage of the pleural cavity is the mainstay of treatment in such cases.

Conclusion: Due to its non-specific presentation BS is difficult to diagnose. In our case, there was a little delay and due to the patient's poor general condition, we managed with conservative treatment.