ABSTRACT

Perforating injuries of the esophagus are separated into four categories: Instrumental injuries, foreign body injuries, non instrumental (barotrauma) injuries, and other rare causes. Injuries due to barotrauma include blunt trauma, Boerhaave’s syndrome and pneumatic lesions from compressed air source. The latter occurs rarely and common sources include accidents involving compressed-air hoses and tanks, or rupture of a bicycle tire when a young child bites on an inner tubing. First described in 1724 by M.D. Hermann Boerhaave as a syndrome related to posthemetic esophageal rupture, the first case with successful surgical management was in 1947 by Barret. The clinical manifestations include hemothorax, hemoneumothorax and free perforation in to the abdominal cavity. Important points in surgical and medical management are: control of the septic focus, appropriate antibiotic management and early nutritional support. There are some reports in medical literature of unusual clinical presentation of this syndrome; however, there are no reports of association between esophageal rupture and the use of non-invasive mechanical ventilation with positive pressure. We present the case of a 70 year old male, who came to the hospital with cough and progressive dyspnea, due to an exacerbation of Chronic Obstructive Pulmonary Disease. Non-invasive Positive Pressure Ventilation (NPPV) was initiated. Three days later shock and hemoperitoneum was detected and a perforation of the distal esophagus was found. Primary repair of the perforation was made with good evolution. The aim of this paper is to present an unusual manifestation of an esophageal perforation associated with NPPV and its successful surgical management.

KEYWORDS

Boerhaave, esophageal rupture, non-invasive mechanical ventilation.

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