• S T Yang, A Devanand, K L Tan, and P C Eng.
• Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608. gm3yty@sgh.com.sg
• Ann Acad Med Singap. 2003 May 1;32(3):415-7.

IntroductionBoerhaave's syndrome is an uncommon condition where there is oesophageal rupture following forceful vomiting, subsequent mediastinitis and is associated with high mortality and morbidity in the absence of therapy. We present a case of Boerhaave's syndrome in a 79-year-old woman who developed a right-sided effusion, an unusual presentation.Clinical PictureA 79-year-old woman developed a right-sided empyema and mediastinitis after a bout of repeated vomiting. Gastrograffin swallows and oesophago-gastroduodenoscopy confirmed oesophageal rupture.TreatmentThe patient was treated with antibiotics and a tube thoracostomy. An open thoracotomy, oesophagostomy and thoracic window was subsequently performed.OutcomeThe oesophageal rupture was contained but patient died from postoperative complications.ConclusionsPhysicians should have a high index of suspicion of oesophageal rupture when patients present with Meckler's triad of symptoms and especially when pleural fluid cultures grow bacteria native to the gastrointestinal tract.

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