症例 challenge · Esophageal surgery / Emergency / Critical care · teaching

Spontaneous Esophageal Rupture (Boerhaave) — Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on StatPearls / Medscape

Case #1Esophageal surgery / Emergency / Critical care

📋 Case data

Hemodynamically stable?Unstable / large leak / septic

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Hemodynamically stable?

Chest pain after forceful vomiting — is the patient hemodynamically stable?

💡 Transmural esophageal perforation after forceful vomiting (usually distal left posterolateral); delay causes mediastinitis/sepsis (24–48 h, high mortality). The Mackler triad (vomiting + chest pain + subcutaneous emphysema) is complete in only a minority, ~1/3 atypical → often misdiagnosed as MI/PE/aortic dissection/pneumothorax/perforated ulcer; severe lower chest/upper abdominal pain after vomiting radiating to the back/left shoulder, worse on swallowing, usually no hematemesis, often a left pleural effusion. Diagnosis: CXR (pneumomediastinum/left effusion/subcutaneous air), CT (first-line, extraluminal air/contrast leak), water-soluble contrast esophagram to localize in stable patients.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.