Clin Exp Otorhinolaryngol.  2008 Sep;1(3):174-176. 10.3342/ceo.2008.1.3.174.

Spontaneous Pharyngeal Perforation After Forceful Vomiting: The Difference from Classic Boerhaave's Syndrome

Affiliations
  • 1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. rohjl@amc.seoul.kr
  • 2Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea.

Abstract

Boerhaave's syndrome is spontaneous transmural perforation of the esophagus, which occurs most often after forceful vomiting or retching. This commonly occurs in the lower third of the esophagus but spontaneous perforation of the pharynx or cervical esophagus is extremely rare. This case presented a 20-yr-old healthy man with spontaneous pharyngeal perforation after forceful vomiting who had no history of instrumentation, cervical trauma, or having eaten anything sharp. Cervical pain and crepitus were the early symptom and sign of pharyngeal perforation and the rupture was detected on gastrografin swallow and CT examinations. The rupture site was higher than the upper esophageal sphincter, differing from Boerhaave's syndrome. The patient was conservatively managed without significant morbidity and mortality. Although this may resolve without surgical intervention, the pharyngeal rupture should receive early detection and clinical attention for preventing potential morbidity by late diagnosis.

Keyword

Spontaneous perforation; Pharynx; Boerhaave's syndrome; Mechanism; Management

MeSH Terms

Delayed Diagnosis
Diatrizoate Meglumine
Esophageal Perforation
Esophageal Sphincter, Upper
Esophagus
Humans
Mediastinal Diseases
Neck Pain
Pharynx
Rupture
Vomiting
Diatrizoate Meglumine
Esophageal Perforation
Mediastinal Diseases

Figure

  • Fig. 1 A gastrografin pre-swallow image showing a small pharyngeal leak (arrows) from the left lateral wall of the oropharynx and air collections (asterisk) in the parapharyngeal and lateral deep cervical spaces.

  • Fig. 2 Axial (A) and coronal (B) CT scans showing a rupture (arrows) of the lateral pharyngeal wall, associated with emphysema in the left parapharyngeal and deep cervical spaces.


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