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EP-53 The ambulatory care of unusual presentation of Boerhaave's syndrome


 Boerhaave's syndrome is a rare but well established clinical condition with spontaneous longitudinal rupture of the oesophagus. It is a life-threatening condition with a mortality rate of up to 40%. The symptoms are variable or classical Mackler triad of Vomiting, chest pain and subcutaneous emphysema are noted. However, it is challenging or missed to diagnose this condition in patients with chronic symptoms.
 We present an unusual presentation of Boerhaave syndrome in a 27-year-old female with no comorbidity presented to the emergency department with acute onset of shortness of breath and chest pain. Blood tests showed elevated D-Dimer on initial evaluation, and the rest of them were unremarkable. A CT pulmonary angiogram was done, which showed thickened lower oesophagus. She was reassured and sent home from the emergency department. Further discussion of the CT images in the upper GI MDT revealed that she had a small sealed off perforation of the oesophagus. The repeat scan after a few days as Outpatient demonstrated a sealed oesophageal perforation and a small collection. The water-soluble contrast swallow did not reveal any leak or stricture in the oesophagus. The patient had a gastroscopy after two months which was reported to be normal. Retrospectively, the patient mentioned that she had an episode of vomiting a few weeks earlier to this acute presentation to the hospital.
 The knowledge about this condition and high suspicion in patients with chronic presentation is vital to diagnosing this potentially lethal condition which could be critical in preventing mortality and morbidity from this condition.