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INTRODUCTION AND IMPORTANCE: Spontaneous esophageal perforation or "Boerhaave" syndrome is an uncommon pathology, with high rates of morbidity and mortality. Clinical scores such as the Pittsburgh classification could guide the treatment and helps to assess mortality risk. Conservative management could be performed in selected cases. CASE PRESENTATION: We present a 19-year-old male patient with a previous history of anxiety and depression, who enters the emergency room with vomiting and epigastric pain followed by swelling at the neck and dysphagia. Neck tomography and chest tomography were obtained showing subcutaneous emphysema. Conservative management was indicated and after 10 days of in-hospital stay and no complications, the patient was discharged. Any complication was observed after 30, 60, and 90 days of follow-up. CLINICAL DISCUSSION: Selected patients with Boerhaave syndrome could benefit from conservative management. Risk classification could be performed using the Pittsburgh score. Nil per os, antibiotic treatment, and nutritional support are the cornerstone of nonoperative management. CONCLUSION: Boerhaave syndrome it's an infrequent pathology, with mortality rates ranging between 30 and 50 %. Early identification and on-time management are required to have favorable outcomes. Pittsburgh score can be used to guide the selection of patients who benefit from conservative treatment.

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INTRODUCTION AND IMPORTANCE: Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures. PRESENTATION OF CASE: A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present. CLINICAL DISCUSSION: The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient's outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction. CONCLUSION: In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.

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Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.

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Abstract Introduction: Typically, when esophageal perforation secondary to barotrauma is mentioned as the causal pathophysiological mechanism of perforation, the literature refers to spontaneous esophageal perforation or Boerhaave syndrome as an entity. It involves the longitudinal and transmural rupture of the esophagus (previously healthy) secondary to an abrupt increase in intraluminal esophageal pressure, frequently triggered during vomiting. However, in the medical literature, some reports list mechanisms of barotrauma other than this entity. Case report: A 64-year-old female patient with a history of surgically managed gastric adenocarcinoma (total gastrectomy and esophagoenteral anastomosis) presented with stenosis of the esophagojejunal anastomosis, which required an endoscopic dilatation protocol with a CRETM balloon. The third session of endoscopic dilation was held; in removing the endoscope, we identified a deep esophageal laceration with a 4 cm long perforation at the level of the middle esophagus (8 cm proximal to the dilated anastomosis), suspecting the mechanism of barotrauma as the causal agent. She required urgent transfer to the operating room, where we performed thoracoscopic esophagectomy, broad-spectrum empiric antimicrobial coverage, and enteral nutrition by advanced tube during in-hospital surveillance. The control esophagram at seven days showed a small leak over the anastomotic area, which was managed conservatively. Imaging control at 14 days showed a decrease in the size of the leak, with good evolution and tolerance to the oral route. The patient was later discharged.

Resumen Introducción: típicamente, cuando se menciona la perforación esofágica secundaria a barotrauma como el mecanismo fisiopatológico causal de la perforación, la literatura se refiere a la perforación esofágica espontánea o síndrome de Boerhaave como entidad, la cual hace referencia a la ruptura longitudinal y transmural del esófago (previamente sano) secundaria a un aumento abrupto de la presión intraluminal esofágica, que se desencadena frecuentemente durante el vómito. Sin embargo, en la literatura médica existen algunos reportes que mencionan otros mecanismos de barotrauma diferentes a esta entidad. Reporte de caso: se presenta el caso de una paciente de 64 años con antecedente de adenocarcinoma gástrico manejado quirúrgicamente (gastrectomía total y anastomosis esofagoenteral), quien presentaba estenosis de anastomosis esofagoyeyunal, que requirió un protocolo de dilatación endoscópica con balón CRETM. Se llevó a una tercera sesión de dilatación endoscópica, en la que durante la extracción del endoscopio se identificó una laceración esofágica profunda con perforación de 4 cm de longitud a nivel del esófago medio (8 cm proximal a anastomosis dilatada), y se sospechó del mecanismo de barotrauma como agente causal. Requirió traslado urgente a sala de cirugía, en la que se realizó esofagorrafia por toracoscopia, cubrimiento antimicrobiano empírico de amplio espectro y nutrición enteral por sonda avanzada durante la vigilancia intrahospitalaria. El esofagograma de control a los 7 días mostró una pequeña fuga sobre el área anastomótica, la cual se manejó de manera conservadora. El control imagenológico a los 14 días evidenció una disminución del tamaño de la fuga, con una evolución satisfactoria y tolerancia a la vía oral, y posteriormente se dio el egreso.

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BACKGROUND: Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION: We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION: Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

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Spontaneous lesions can affect only a part of the esophageal wall (Mallory-Weiss syndrome) or constitute a full-thickness rupture of the organ, leading to Boerhaave syndrome. Most commonly affecting males between 50 and 70 years of age, Clinically, the Mackler triad is vomiting, severe chest pain, and subcutaneous cervical emphysema. The delay in diagnosis explains the high mortality rate of this pathology up to 40-60% in those treated at 48 hours. The prognosis improves if treatment is established within the first 24 hours.

Las lesiones espontáneas pueden afectar solo una parte de la pared esofágica (síndrome de Mallory-Weiss) o constituir una rotura de espesor total del órgano, dando lugar al síndrome de Boerhaave. Afecta con mayor frecuencia a los varones entre 50 y 70 años de edad. Clínicamente conforma la tríada de Mackler: vómito, dolor torácico intenso y enfisema subcutáneo cervical. El retraso en el diagnóstico explica su alta tasa de mortalidad, de hasta el 40-60% en los pacientes tratados a las 48 horas. El pronóstico mejora si se logra instaurar el tratamiento dentro de las primeras 24 horas.

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An 83-year-old female patient presented to the Emergency Department with shortness of breath, difficulty swallowing and left-sided chest pain following a vomiting attempt. A rupture in the left lower third of the esophagus, with hydropneumothorax, pneumomediastinum, and subcutaneous emphysema was revealed by chest X-ray, thoracic computed tomography scan, and contrast esophagography. The patient was successfully treated conservatively with closed thoracostomy, intravenous fluids, parenteral nutrition, and broad-spectrum antibiotics coverage. Following the successful conservative treatment, the patient developed a distal esophageal stenosis which was treated with an intra-esophageal self-expanding stent.

Una paciente de 83 años acudió al Servicio de Urgencias con disnea, dificultad para tragar y dolor en el lado izquierdo del pecho tras un intento de vómito. Una rotura en el tercio inferior izquierdo del esófago, con hidroneumotórax, neumomediastino y enfisema subcutáneo fue revelada por radiografía de tórax, tomografía computarizada de tórax y esofagografía con contraste. El paciente fue tratado con éxito de manera conservadora con toracostomía cerrada, líquidos intravenosos, nutrición parenteral y cobertura de antibióticos de amplio espectro. Tras el exitoso tratamiento conservador, el paciente desarrolló una estenosis esofágica distal que fue tratada con un stent autoexpandible intraesofágico.

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INTRODUCTION: Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE: To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT: 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS: The delay in diagnosis contributed to the fatal outcome of the patient.

INTRODUCCIÓN: El síndrome de Boerhaave consiste en una perforación espontánea del esófago, con alta mortalidad. OBJETIVO: Describir un caso de síndrome de Boerhaave con doble perforación esofágica. CASO CLÍNICO: Mujer de 33 años que acude al hospital por un cuadro emético, seguido de dolor torácico retroesternal; se realiza drenaje torácico. Se diagnostica tardíamente perforación esofágica y se traslada a una institución de nivel terciario. Se realizaron sucesivos tratamientos: videotoracoscopia y decorticación pleural, yeyunostomía alimentaria, colocación de endoprótesis esofágica, diagnóstico de nueva perforación, exclusión pilórica, colocación de nueva endoprótesis y exclusión esofágica. CONCLUSIONES: El retardo en el diagnóstico contribuyó al desenlace fatal de la paciente.

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Resumen La perforación esofágica espontánea es una forma rara de ruptura del grosor de la pared del esófago sano, de manera no traumática. Es característico verla en pacientes de mediana edad, con obesidad y alcohólicos, que tienen episodios violentos de náuseas y vómitos. El tratamiento de la perforación esofágica espontánea depende de varios factores, como la etiología, sitio de la perforación, tiempo transcurrido desde la perforación hasta el diagnóstico, el grado de la contaminación del peritoneo o mediastino, comorbilidades, y estado general del paciente. En este artículo se presenta el caso de un paciente con enfisema subcutáneo en la parte superior del tórax, cuello y cara; con taquicardia de 115 latidos por minuto, hemograma con 18 mil leucocitos con predominio de neutrófilos. Se le realizaron radiografías de tórax y senos paranasales, donde se observa aire entre partes blandas y hueso. Se le realiza tratamiento quirúrgico con cierre de la perforación por toracotomía izquierda, se deja alimentación por sonda nasogástrica y antibióticos por 7 días.

Abstract Spontaneous esophageal perforation is a rare form of non-traumatic rupture of the thickness of the wall of the healthy esophagu. It is observed in middle-aged, obese, and alcoholic patients who have violent episodes of nausea and vomiting. Treatment of spontaneous esophageal perforation depends on several factors, such as the etiology, site of the perforation, time from perforation to diagnosis, degree of contamination of the peritoneum or mediastinum, comorbidities, and general condition of the patient. This article presents the case of a patient with subcutaneous emphysema in the upper part of the chest, neck and face; with a heart rate of 115 beats per minute, with a blood count of 18,000 leukocytes with a predominance of neutrophils. X-rays of the chest and paranasal sinuses were performed, where air is observed between soft tissue and bone. Surgical treatment is performed with closure of the perforation by left thoracotomy, feeding by nasogastric tube and antibiotics is left for 7 days.

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Resumen: La perforación esofágica espontánea o síndrome de Boerhaave es una entidad poco frecuente. Se define como la rotura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Las roturas esofágicas se consideran como la perforación más grave del tracto digestivo, con una alta tasa de morbimortalidad relacionada principalmente con el desarrollo de mediastinitis posterior. Presentamos un paciente de sexo masculino de 63 años, que postingesta copiosa presenta esfuerzo de vómito inefectivo y posteriormente intenso dolor epigástrico, acompañado de enfisema subcutáneo. Se realiza tomografía de tórax que evidencia colección de contraste paraesofágica. Con planteo de síndrome de Boerhaave se decide cirugía de urgencia. Destacamos que el principal elemento pronóstico es el tiempo de resolución quirúrgica, por lo que debemos considerar esta patología como diagnóstico diferencial en pacientes con dolor torácico de inicio agudo.

Summary: Spontaneous esophageal perforation or Boerhaave syndrome is rather an unusual condition. It may be defined as the rupture of the esophagus that is not associated to trauma, invasive explorations, previous esophagus pathology or foreign bodies. Esophageal ruptures are considered as the most severe perforations of the digestive tract, with high morbimortality rates which are mainly associated to the development of subsequent mediastinitis. The study presents a 63-year-old patient who, after copious food intake, evidences unsuccessful effort to vomit effort and subsequent intense epigastric pain, accompanied by subcutaneous emphysema. Abdominal contrast scan reveals paraesophageal collection and a decision is made to perform an emergency surgery upon the suspicion of Boerhaave syndrome. It is worth pointing out that time for surgical resolution is the main prognostic element, and thus, this condition is to be considered as differential diagnosis in patients with acute thoracic pain.

Resumo: A perfuração esofágica espontânea ou síndrome de Boerhaave é uma entidade rara. É definida como ruptura do esôfago não relacionada a trauma, exames invasivos, patologia esofágica prévia ou corpos estranhos. As rupturas esofágicas são consideradas as perfurações mais graves do trato digestivo, com alto índice de morbimortalidade principalmente relacionado ao desenvolvimento de mediastinite posterior. Apresentamos um paciente do sexo masculino, 63 anos, que após ingestão abundante apresentou esforço ineficaz de vômito e, posteriormente, dor epigástrica intensa, acompanhada de enfisema subcutâneo. Foi realizada tomografia de tórax que evidenciou coleção de contraste paraesofágico. Com diagnóstico de síndrome de Boerhaave, a cirurgia de emergência foi decidida. Ressaltamos que o principal elemento prognóstico é o tempo de resolução cirúrgica, portanto, devemos considerar essa patologia como um diagnóstico diferencial em pacientes com dor torácica de início agudo.

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La perforación esofágica es la más letal de todas las perforaciones del aparato digestivo. Se presenta el caso de un varón de 65 años que acude a urgencias por un cuadro clínico de dolor torácico, vómitos e hipotensión. Se le realizó tomografía computarizada por sospecha de síndrome aórtico agudo, con hallazgos sugerentes de perforación esofágica. El síndrome de Boerhaave consiste en la rotura longitudinal del esófago sobre una pared macroscópicamente sana. Su tratamiento definitivo se realiza con cirugía durante las primeras 24 horas. El síndrome de Boerhaave debe considerarse como complicación posible en los pacientes con dolor epigástrico y vómitos, ya que es una emergencia quirúrgica con alta morbimortalidad.Esophageal perforation is the most lethal of all perforations of the digestive system. 65-year-old male who goes to the emergency department due to clinical symptoms of chest pain, vomiting and hypotension, who underwent CT scan for suspected acute aortic syndrome, with suggestive findings of esophageal perforation. Boerhaave syndrome consists of the longitudinal rupture of the esophagus on a macroscopically healthy wall. Its definitive treatment is performed with surgery during the first 24 hours. Boerhaave syndrome should be considered as a possible complication in patients with epigastric pain and vomiting, as it is a surgical emergency with high morbidity and mortality.

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RESUMEN Introducción: La perforación del esófago constituye una de las urgencias más graves y difíciles que ha de afrontar un cirujano por las características y ubicación del órgano. El pronóstico depende sobre todo de la rapidez del diagnóstico y de la elección del tratamiento instaurado en principio. Objetivo: Presentar un caso portador del Síndrome de Boerhaave. Caso clínico: Paciente masculino en la 5ta década de vida que acudió por dolor torácico posterior a cuadro emético. Luego de estudio radiográfico se diagnosticó ruptura espontánea de esófago o síndrome de Boerhaave. Conclusiones: El enfoque terapéutico adecuado asociado al diagnóstico oportuno y precoz del síndrome garantiza mejores índices de sobrevida(AU)

ABSTRACT Introduction: Esophageal perforation is one of the most serious and difficult emergencies that a surgeon has to face due to the characteristics and location of the organ. Such prognosis depends mainly on the speed of the diagnosis and the choice of treatment established initially. Objectives: To present a case with such syndrome and to review the literature to update the therapeutic approach of this entity given its high mortality. Clinical case: Male patient in the fifth decade of life who presented for chest pain after an emetic condition. After a radiographic study, a spontaneous rupture of the esophagus or Boerhaave syndrome was diagnosed. Conclusions: The appropriate therapeutic approach associated with the early and timely diagnosis of the syndrome guarantees better survival rates(AU)

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BACKGROUND: In the year 1724, Hermann Boerhaave reported a case of a Dutch admiral who died due to spontaneous rupture of the esophagus following vomiting. The aim of this retrospective study is to analyze the therapeutic modality, morbidity and mortaliy of a group of patients with spontaneous esophageal rupture treated in our hospital. METHODS: Ten patients were treated from March 1990 to August 2016. Seven patients were males and three were females. The age range was, 52-72 years, with an average of 66.2 years. In four patients, the diagnosis and posterior treatment were performed within 24 h (Group I) and the remaining six patients after 24 h (Group II). RESULTS: The mean hospital stay was 36.6 days (range 17-62 days). The mortality rate was 50%, which was due to septic shock and the morbidity of patients who survived was 40% due to pneumonia in one case and fistula in another. DISCUSSIONS: This condition has a high mortality rate with a lethality that depends on the time between recognition of symptoms and proper surgical treatment.

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El neumomediastino espontáneo es una entidad poco frecuente, caracterizada por la presencia de aire en el mediastino sin mediar antecedente traumático o iatrogénico. Fue descrito por primera vez en 1939 por Hamman, quien lo caracteriza como un síndrome que presenta dolor torácico y disnea, y cuya principal manifestación al examen físico es el enfisema subcutáneo. A continuación se presenta el caso clínico de un varón de 22 años con antecedentes de asma, tabaquismo activo y abuso de drogas, quien luego de consumir cocaína presenta un cuadro de 2 días de evolución de dolor cervical, al que posteriormente se le agrega disnea y sensación de opresión torácica, con enfisema subcutáneo al examen físico como único hallazgo. Se confirma el diagnóstico de neumomediastino espontáneo mediante radiografía de tórax posteroanterior (PA), y es hospitalizado por sospecha de mediastinitis la que posteriormente es descartada, evolucionando el paciente de forma favorable al cabo de 8 días de observación y tratamiento antibiótico preventivo. Se presenta el caso para revisar la incidencia de la patología, los factores de riesgo asociados, y principales diagnósticos diferenciales con el fin de mejorar la pesquisa en servicios de urgencia.

Spontaneous pneumomediastinum is an uncommon entity characterized by the presence of air in the mediastinum and not associated with trauma or iatrogenesis. It was first described by Hamman in 1939, who characterized it as a syndrome presenting with thoracic pain and dyspnea with subcutaneous emphysema on physical examination. We present the clinical case of a 22 year old asthmatic male who was an active smoker and drug abuser who, after using cocaine, suffered two days of neck pain then, in addition, dyspnea and thoracic oppression; subcutaneous emphysema being the only physical finding. Diagnosis was confirmed by an antero-posterior chest film, the patient was hospitalized with suspected mediastinitis, diagnosis which was subsequently discarded, and the patient responded favorably to 8 days observation and preventive antibiotics. We are presenting the case in order to review the incidence of this pathology, its risk factors and principal differential diagnoses in order to improve its detection rate in emergency services.

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La perforación esofágica espontánea (PEE) o síndrome de Boerhaave es una entidad poco frecuente, consiste en la ruptura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Independientemente de su mecanismo de producción, la perforación esofágica se considera como la más grave del tracto digestivo. Si su diagnóstico y reparación quirúrgica se retrasan, el pronóstico se ensombrece de forma notable. Presentamos un caso de paciente masculino de 37 años, sin antecedentes de interés que consulta a emergencia por cuadro brusco de dolor epigástrico irradiado a región retroesternal, posterior a vómito de contenido alimentario. El paciente presenta progresivamente deterioro de sus condiciones ventilatorias, que ameritan traslado a UCI y 72 horas posterior a ingreso a UCI se realizó esofagograma con bario evidenciándose extravasación de medio de contraste en tercio distal esofágico, aproximadamente 3 cm por encima de hemidiafragma izquierdo, por lo que de inmediato se decide colocación de stent metálico parcialmente cubierto Wilson-Cook (Evolution) bajo visión endoscópica y fluoroscópica, con resolución completa de la sintomatología

Spontaneous esophageal perforation (SEP) or Boerhaave syndrome is a rare entity that consists in the rupture of the esophagus unrelated to trauma, invasive examinations, previous esophageal disease or the presence of foreign bodies. Regardless of its mechanism, esophageal perforation is considered the most serious of the digestive tract. If diagnosis and surgical repair are delayed the outlook worsens considerably. We present the case of a 37-year-old male patient in good health, who attends the emergency room because of sudden onset of epigastric pain radiating to the retrosternal region after vomiting. The patient´s ventilatory condition deteriorated progressively meriting transfer to the intensive care unit; 72 hours after admission, a barium esophagram showed dye extravasation in the distal esophagus, approx 3 cm above the left diaphragm. We immediately decided to place a Wilson-Cook partially covered metal stent (Evolution) through endoscopic and fluoroscopic guidance with complete resolution of symptoms

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Spontaneous oesophageal rupture (Boerhaave's syndrome) is extremely rare in children. Presentation is usually in middle aged men as a result of vomiting following heavy food or alcohol consumption. We describe an unusual case of a 12-year old boy without significant past medical history presenting with acute chest pain following gastroenteritis.

La ruptura esofágica espontánea (síndrome de Boerhaave) es extremadamente rara en niños. Por lo general se presenta en hombres de mediana edad como resultado vómitos tras la ingestión de alcohol o alimentos pesados. Describimos un caso inusual de un niño de 12 años de edad sin antecedentes clínicos significativos, que acudió con dolor torácico agudo tras una gastroenteritis.

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El síndrome de Boerhaave o perforación esofágica espontánea es una enfermedad grave que pone en riesgo la vida y amerita un diagnóstico oportuno. Sin tratamiento médico o quirúrgico es prácticamente letal. El cuadro clásico es el del paciente que presenta vómito y posteriormente dolor epigástrico o retroesternal. Caso Clínico: se rata de peciente femenina de 23 años de edad quien consulto por presentar Posterior a ingesta de alimentos sensación de deglución incompleta, vómitos de contenido Hematico y dolor retroesternal. Se realiza Gastroscopia evidenciándose en esófago a 25 cm. laceración lineal profunda que se extiende hasta los 33cm TAC de tórax reporto: Neumonediastino, Signos sugestivos de perforación esofágica; Se realizo Toracotomia Posterolateral derecha, encantándose 50cc de liquido libre en cavidad, hematoma mediastinal de 4 x 4 cm y enfisema mediastinal. La paciente permaneció hospitalizada por varios días recibiendo tratamiento medico evolucionando satisfactoriamente sin complicaciones. Conclusiones: el diagnóstico y tratamiento precoces del SB es muy importantes ya que permiten reducir las altas tasas de morbilidad y mortalidad asociadas a este cuadro. Sin embargo, el diagnóstico de esta entidad muestra en general retraso en prácticamente todas las series (en la mitad de los casos el diagnóstico se realiza con más de 24 horas de evolución), ya que en muchas ocasiones los síntomas son inespecíficos y no típicos, además los hallazgos clínicos y radiológicos pueden no ser aparentes en las primeras horas tras la perforación. Estudios de Endoscopia, esofagograma, TAC proporcionan el diagnóstico.

Boerhaave syndrome or spontaneous esophageal perforation is a serious condition that endangers the patient´s life and deserves an opportune diagnosis. Without medical or surgical treatment is practically lethal. The classic presentation is the patient who presents with vomits and immediately after with epigastric or retrosternal pain. Clinical case: a 23 years old female patient consulted presenting, after food ingestion, a subsequent sensation of incomplete swallowing, vomits with hematic content and retrosternal pain. A gastroscopy was performed demonstrating deep linear esophagial laceration at 25 cm extending at 33cm CT scan reported pneumonediastin, with suggestive signs of esophageal perforation; She went through a right posterolateral toracotomy, 50cc of free liquid was found in cavity, a 4 x 4 cms mediastinal hematoma and emphysema. The patient remained hospitalized for several days receiving medical treatment without complications. Conclusions: early diagnosis and treatment of BS is important becuase it reduces the high morbidity and mortality rates associated with this syndrome. Nevertheless, the diagnosis is usually delayed in practically all series (in half of the cases the diagnosis is done after more than 24 hours), since in many occasions the symptoms are inespecífic and non-typical. in addition the clinical and radiological findings are not apparent in the first hours after perforation. Studies as endoscopy, esophagogram, CT scan provide the diagnosis.