0 Boerhaave's syndrome vs Mallory–Weiss syndrome

Boerhaave's syndrome vs Mallory–Weiss syndrome

Boerhaave's syndrome

Mallory–Weiss syndrome

Site :  Lower thoracic oesophagus

Site: Vertical tear in cardia of stomach , may extend to distal oesophagus.

There is vertical perforation, and all gastric content goes into mediastinum.
No history of foreign body.

Mackler's triad may be seen :
  • Chest pain, 
  • vomiting and 
  • subcutaneous emphysema

Mucosa and submucosa are involved, NOT a complete perforation.
Presentation : Hematemesis (Not pain)

Reason : Vomiting / Retching against closed cricopharynx. i.e barotrauma

Reason : Vomiting , Increased LES (Lower esophageal sphincter)  pressure. –  can cause tear.

Sign : Air in mediastinum

Hamman’s Sign  (seen with any cause of pneumomediastinum.) – On auscultation , because of air around heart.

Investigation of Choice : Water soluble contrast study ( DO NOT USE BARIUM)

Diagnosis : Upper GI endoscopy.

Treatment : Immediate surgery
(via LEFT thoracotomy )

If >24-48 hrs – Let heal with secondary intention , do not suture , Just put a drain.

Treatment : Conservative (95 % cases)

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

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