Boerhaave syndrome pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamed Diab, MD [2] Shaghayegh Habibi, M.D.[3]
Overview
Boerhaave syndrome is a spontaneous longitudinal perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure. It is commonly associated with the consumption of excessive food and/or alcohol or underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett's or infectious ulcers.
Pathophysiology
Pathogenesis
- Boerhaave syndrome is a spontaneous perforation of the esophagus due to a sudden rise in intraesophageal pressure combined with negative intrathoracic pressure (eg, severe straining, vomiting or seizures) as a result of neuromuscular incoordination resulting in a longitudinal esophageal perforation.[1]
- The most common anatomical location of the esophageal perforation in Boerhaave syndrome is at left posterolateral wall of the distal intrathoracic esophagus (the distal third of the esophagus is inherently weaker than the rest of the esophagus) and 2-3 cm before the stomach. However, the esophageal perforation in Boerhaave syndrome can also occur in the cervical or intra-abdominal esophagus.[2]
Associated conditions
- Boerhaave syndrome usually occurs in patients with a normal underlying esophagus and some patients has underlying medication-induced esophagitis, eosinophilic esophagitis, Barrett's or infectious ulcers.[3][4]
- Boerhaave syndrome is commonly associated with the consumption of excessive alcohol intake or over eating, or both, because either of these can induce vomiting.[5][6]
Gross pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name]
Microscopic pathology
- In Boerhaave syndrome the microscopic pathology is based on the underlying esophagus which could be normal, eosinophilic esophagitis, Barrett's or infectious.[3]
References
- ↑ Pate JW, Walker WA, Cole FH, Owen EW, Johnson WH (1989). "Spontaneous rupture of the esophagus: a 30-year experience". Ann. Thorac. Surg. 47 (5): 689–92. PMID 2730190.
- ↑ Razi E, Davoodabadi A, Razi A (2013). "Spontaneous esophageal perforation presenting as a right-sided pleural effusion: a case report". Tanaffos. 12 (4): 53–7. PMC 4153269. PMID 25191485.
- ↑ 3.0 3.1 Jackson WE, Mehendiratta V, Palazzo J, Dimarino AJ, Quirk DM, Cohen S (2013). "Boerhaave's syndrome as an initial presentation of eosinophilic esophagitis: a case series". Ann Gastroenterol. 26 (2): 166–169. PMC 3959943. PMID 24714779.
- ↑ Straumann A, Bussmann C, Zuber M, Vannini S, Simon HU, Schoepfer A (May 2008). "Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients". Clin. Gastroenterol. Hepatol. 6 (5): 598–600. doi:10.1016/j.cgh.2008.02.003. PMID 18407800.
- ↑ Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B (March 2013). "Boerhaave's syndrome: diagnosis and successful primary repair one month after the oesophageal perforation". Ghana Med J. 47 (1): 53–5. PMC 3645189. PMID 23661858.
- ↑ Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B (March 2013). "Boerhaave's syndrome: diagnosis and successful primary repair one month after the oesophageal perforation". Ghana Med J. 47 (1): 53–5. PMC 3645189. PMID 23661858.