Clinical and epidemiological aspects of Boerhaave’s Syndrome

Abstract

Boerhaave’s syndrome is a spontaneous transmural rupture of the esophagus, usually located in the distal intrathoracic portion, to the left of the mid-esophageal third, often associated with intense vomiting following excessive food or alcohol intake. It is a rare and severe medical emergency, with a mortality rate ranging from 35% to 40%, reaching up to 100% in untreated cases beyond 48 hours. This study aimed to identify the main clinical and epidemiological aspects of Boerhaave’s syndrome. A narrative literature review was conducted using the PubMed, SciELO, LILACS, and Google Scholar databases, with the descriptors “Boerhaave’s syndrome,” “spontaneous esophageal rupture,” “epidemiology,” and “esophageal perforation.” The syndrome accounts for 15% to 20% of esophageal perforations, with an estimated incidence of 3.1 cases per million inhabitants per year, predominantly affecting men aged 50 to 70 years. In over 90% of cases, it is associated with excessive alcohol or food intake, with vigorous vomiting being the triggering factor in 56% of reports. Although classical signs such as Mackler’s triad and Hamman’s sign are described, both have low prevalence, which hampers early diagnosis. Clinical manifestations range from odynophagia to severe retrosternal chest pain with radiation, and may progress to shock in advanced stages. Differential diagnosis includes conditions such as acute myocardial infarction, aortic dissection, pulmonary embolism, and pancreatitis, as well as Mallory-Weiss syndrome, which differs by presenting mucosal laceration without transmural rupture. Diagnosis confirmation relies on imaging exams such as computed tomography and contrast esophagography, with early recognition and intervention within the first 24 hours being crucial for improving prognosis.