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Ann Acad Med Singapore. 2003 May;32(3):415-7.
Boerhaave's syndrome presenting as a right-sided pleural effusion.

Yang ST, Devanand A, Tan KL, Eng PC.

Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. gm3ytgh.com.sg

INTRODUCTION: Boerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation. CLINICAL PICTURE: A 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture. TREATMENT: The patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed. OUTCOME: The oesophageal rupture was contained but patient died from postoperative complications. CONCLUSIONS: Physicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.


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