Esophageal Perforations

Question 1

2 syndromes included in esophageal perforations?

Answer 1

Mallory-Weiss Syndrome
Boerhaave Syndrome

Question 2

Mallory-Weiss vs Boerhaave Syndrome

Which one is a complete perforation (transmural)?

Answer 2

Boerhaave Syndrome

Mallory-Weiss Syndrome is limited to the submucosa

Question 3

Mallory-Weiss vs Boerhaave Syndrome

Which esophageal perforation is typically higher up?

Answer 3

• Boerhaave is usually on the LT posterolateral wall of the lower esophagus (3-5cm ABOVE the gastroesophageal junction)
• Mallory-Weiss is usually at the gastroesophageal junction

Question 4

Mallory-Weiss vs Boerhaave Syndrome

Which has worse symptoms?

Answer 4

Boerhaave Syndrome

bc full thickness rupture

Question 5

Mallory-Weiss vs Boerhaave Syndrome

Pt has severe pleuritic retrosternal CP that is worse when taking deep breaths or swallowing. PE shows crepitus and Hamman’s sign (mediastinal “crackle/crunch” with every heart beat)

Answer 5

Boerhaave Syndrome

Question 6

Test of choice for Mallory-Weiss Syndrome?

Answer 6

Upper Endoscopy

Question 7

Test of choice for Boerhaave syndroem?

Answer 7

Esophagram + Gastrografin Contrast

if inconclusive -> get Chest CT

Question 8

Trmnt for Mallory-Weiss Syndrome?

Answer 8

supportive
Most cases stop bleeding w/o trmnt
PPIs may help promote healing

Question 9

Trmnt for Boerhaave Syndrome?

Answer 9

NPO
IV ABX
IV PPIs - Esmeprazole (Nexium)
Sx Consult (large or severe ones need Sx repair)