Esophageal Stenosis as a Cause of Spontaneous Esophageal Perforation (Boerhaave Syndrome): A Case Report and Explanation of Possible Mechanism

Introduction: Boerhaave syndrome (BS) is a spontaneous perforation of the esophagus which depends on increased intra-esophageal pressure, while the upper sphincter is closed during excessive vomiting. Case: A 75-year-old man was referred to hospital with sudden chest pain after vomiting. A computed chest tomography demonstrated mediastinal emphysema, thickening of the wall at the esophago-gastric junction level, and left pleural effusion. An upper gastrointestinal endoscopy showed an esophageal stenosis at mid thoracic portion and a perforation detected just 1 cm above of the lower gastro-esophageal sphincter. The patient underwent left posterolateral thoracotomy in the 12th hour of event. Stenotic segment is dilated and the mucosal perforation was repaired. Conclusion: BS is a serious disease with high morbidity and mortality rates. While BS usually occurs in a normal esophagus; in our case, BS was due to esophageal benign stenosis instead of upper sphincter esophageal sphincter closure. Benign stenosis may facilitate perforation as seen in our patient due to increased intraluminal pressure following vomiting.