A note on importance of high vigilance for Boerhaave syndrome

Diagnosis of Boerhaave syndrome is difficult as about one third of all cases of Boerhaave syndrome are clinically atypical. Even with clinical signs, Boerhaave syndrome is usually misdiagnosed as acute myocardial infarction, pancreatitis, pleuritis, pericarditis, Aortic dissection or pneumothorax etc. Radiographic studies should be promptly obtained.

Overall mortality is estimated to be around 35%, making it the most lethal perforation of the GI tract. The best outcomes are associated with early diagnosis and definitive surgical management within 12 hours of rupture. If intervention is delayed longer than 24 hours, the mortality rate rises to higher than 50% and to nearly 90% after 48 hours. Left untreated, the mortality rate is close to 100%.