Write about Spontaneous Rupture of the Oesophagus here.

• Boerhaave's Syndrome AKA

• Rare but catastrophic

• Typically occurs when attempting to suppress vomiting by closure of pharyngeal sphincter -> intra-ooesophageal pressure rises -> rupture occurs (typically in lower 1/3)

• More severe form of Mallory-Weiss syndrome of haematemesis due to mucosal tears

• Characteristically vomiting is followed by chest pain and subcutaneous emphysema (palpable air in skin) as air and gastric contents leak into the mediastinum

• A few hours later the pleural membrane gives way and air and food debris pass into the pleural cavity producing pleuritic pain, pleural effusion and empyema

• CXR typically shows an initial pneumomediastinum (rim of air around the mediastinal structures), followed by hydropneumothorax

• Notoriously difficult diagnosis

• Radiocontrast oesophagogram is the key investigation

• Thoracotomy with repair is the best treatment