Rare Esophageal Rupture Following Food Poisoning Nearly Claims Man’s Life
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A 59-year-old man in China experienced a life-threatening medical emergency after a bout of food poisoning led to a spontaneous rupture of his esophagus, a condition known as Boerhaave syndrome. The case, recently detailed in The New England Journal of Medicine, underscores the potentially devastating consequences of severe vomiting and the critical need for rapid medical intervention.
The patient’s ordeal began shortly after consuming a meal that triggered intense food poisoning. He arrived at the emergency room at Qilu Hospital of Shandong University in Qingdao approximately five and a half hours after ingesting the contaminated food, complaining of excruciating chest pain that worsened with each breath.
The Peril of Boerhaave Syndrome
According to the medical team, led by Doctors Penghui Wei and Wenyong Zhu, the man’s forceful vomiting caused a tear in his esophagus – the muscular tube connecting the throat to the stomach. This spontaneous rupture, Boerhaave syndrome, is a rare but often fatal condition typically triggered by severe vomiting or nausea. Without prompt treatment, the mortality rate can range from 60% to 100% within 12 to 24 hours.
Initial examination revealed alarming signs. Doctors observed rapid and shallow breathing, accompanied by crackling sounds in the patient’s neck. Lung auscultation indicated diminished breath sounds in the right lung. A subsequent CT scan confirmed the presence of air in the chest cavity and neck, along with fluid accumulation around the lungs, leading to a right lung collapse. The scan also definitively identified a perforation of the esophagus.
Emergency Intervention and Lengthy Recovery
The immediate course of action involved inserting a chest drain to evacuate the fluid surrounding the lungs. Notably, the fluid did not contain stomach contents, suggesting a primary pulmonary inflammation. Further diagnostic testing, including an esophagram – an X-ray of the esophagus using a water-soluble contrast dye – clearly revealed a substantial tear caused by what was described as a “bile rash.” Imaging also showed the contrast medium leaking into the chest cavity.
The patient underwent emergency surgery to repair the esophageal tear and remained hospitalized for over a month. Upon discharge, he required continued nourishment via a nasogastric tube inserted into his small intestine. A complete healing of the esophagus took an additional three months, after which the feeding tube could finally be removed.
A Rare, and Possibly Underreported, Condition
Boerhaave syndrome affects approximately three people per million worldwide annually, but researchers suspect the actual incidence is higher due to underreporting. The precise cause of the syndrome remains unclear, but it is believed to be linked to a disruption in the neuromuscular coordination that controls the upper esophageal sphincter during vomiting. This lack of coordination can lead to a sudden and dramatic increase in internal pressure, resulting in a lengthwise tear – often up to eight centimeters long – in the lower esophagus.
This case serves as a stark reminder of the potential severity of food poisoning and the importance of seeking immediate medical attention when experiencing severe vomiting or chest pain. .
