When Vomiting Is More Than a Hangover: A Near-Missed Boerhaave Syndrome

Author : Sam Jia Ying, Lai Sin Nan

Abstract : Boerhaave’s syndrome is a life-threatening condition defined by full-thickness esophageal perforation following a sudden increase in intra-esophageal pressure, commonly due to forceful vomiting. Leakage of esophageal contents into the mediastinal, pleural, or peritoneal spaces can result in mediastinitis, pneumonitis, or peritonitis, rapidly progressing to shock[4]. We report a case of a patient who presented with chest discomfort, breathlessness, and vomiting after alcohol consumption. He was initially treated for alcohol intoxication with transient improvement following intravenous hydration. However, he subsequently deteriorated with worsening tachypnea and hypoxia. A CT thorax performed during a repeat Emergency Department visit revealed esophageal perforation with left hydropneumothorax. This case highlights that Boerhaave’s syndrome may present with subtle and misleading early symptoms, leading to misdiagnosis. A high index of suspicion is essential in patients with forceful vomiting and chest pain to enable early diagnosis and timely surgical intervention, thereby reducing morbidity and mortality

Keywords : Boerhaave Syndrome, esophageal perforation, chest pain, hydropneumothorax, diagnostic challenge, surgical emergency, and early diagnosis.

Conference Name : International Conference on Gastrointestinal Disorders and Management (ICGDM-26)

Conference Place : Kuala Lumpur, Malaysia

Conference Date : 28th May 2026