A middle aged man complains of upper abdominal pain after a heavy meal. There is tenderness in the upper abdomen and on X-ray, widening of the mediastinum is seen with pneumo-mediastinum. What is the diagnosis?: (A) Spontaneous perforation of the esophagus, (B) Perforated peptic ulcer, (C) Foreign body in esophagus, (D) Rupture of emphysematous bulla
Answer is A. Above clinical scenario is suggestive of diagnosis of spontaneous perforation of the esophagus. Aka BOERHAAVE Syndrome - Caused by Forceful vomiting Repeated vomiting - Clinical features - Characterized byMackler's triad Thoracic Pain Vomiting Cervical subcutaneous emphysema Investigation - On CXR - Hydropneumothorax - IOC for Dx - Water soluble contrast esophagogram (Gastrograffin > Hypaque)