Vomiting-induced pneumomediastinum as a result of recurrent Boerhaave's syndrome. Issue 5 (1st June 2020)

• Record Type: Journal Article
• Authors: Kyriakides, Jonathon; Stackhouse, Ashlyn
• Is Part Of: Journal of surgical case reports. Volume 2020:Issue 5(2020)
• Publication Date: 2020-06-01
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjaa102
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: Vomiting-induced pneumomediastinum can be a result of barotrauma causing alveolar rupture or Boerhaave's syndrome. Although a rare cause of secondary pneumomediastinum, Boerhaave's syndrome allows extravasation of air and fluid due to oesophageal perforation. We report a case of a 20-year-old female who presented with prolonged vomiting during a panic attack. Extensive surgical emphysema and pneumomediastinum were visualised radiologically. A source of oesophageal rupture was not visualised on cross-sectional computed tomography imaging following contrast ingestion. A complication of mediastinitis provided the evidence that this was a case of Boerhaave's syndrome whereby microscopic perforation of the oesophagus led to secondary pneumomediastinum, rather than vomiting-induced spontaneous pneumomediastinum caused by barotrauma. Recurrent Boerhaave's syndrome in this case is owed to the patient having previously experienced identical symptoms which spontaneously resolved.