Boerhaave's Syndrome: When Vomiting Ruptures the Esophagus

Boerhaave's Syndrome: When Vomiting Ruptures the Esophagus
AP Photo/Laurent Cipriani
Boerhaave's Syndrome: When Vomiting Ruptures the Esophagus
AP Photo/Laurent Cipriani
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Ultra-running is an exhausting and potentially dangerous sport. Athletes test their stamina over distances of fifty or even one hundred miles, facing fatigue, dehydration, and bodily injury over strenuous outdoor courses that often traverse mountains and forests.

According to a new report in the journal BMJ Case Reports, one 37-year-old ultra-running competitor faced an unlikely and dangerous peril during his 100-mile trek from Squaw Valley, California to Auburn, California: a ruptured esophagus.

What specifically happened to the man is called Boerhaave's Syndrome, an esophageal tear caused by vomiting, but this wasn't immediately obvious to his care providers. The man's sudden and severe left-sided chest pain and difficulty breathing could have indicated a heart attack, rib fracture, collapsed lung, or a blood clot in the lungs, all of which are far more common than Boerhaave's. The esophagus is the tube that connects the throat to the stomach, and it does not rupture easily. Spontaneous ruptures are incredibly rare, occurring in fewer than one in a million people each year.

For more than 200 years after Dutch physician Hermann Boerhaave originally described them in 1724, they were also almost always fatal. In 1947, surgeons pioneered a method to repair the esophagus. Physicians now estimate the mortality rate to be between 2% and 20%. Boerhaave's is so dangerous because food or liquids can quickly leak from the esophagus into the lungs and wreak havoc.

Luckily for our ultra-runner, his doctors noticed the esophageal tear after repeated x-rays and CT scans. Surgeons repaired the damage, but extensive recovery was still required.

"I ended up spending a total of 41 days in three hospitals and over 30 days being fed through a J-tube," the man recalled. "I had to learn to breathe again, walk again, and after 70 days I was able to start running again. The whole experience gave me a new perspective on life and the importance of health, and I have learnt to appreciate the little things in life."

Source: Pasternak A, Ellero J, Maxwell S, et al. "Boerhaave’s syndrome in an ultra-distance runner." BMJ Case Reports CP 2019;12:e230343.

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