This occurs classically when a person vomits against a closed glottis. The pressure in the oesophagus increases rapidly, and the oesophagus bursts at its weakest point in the lower third, sending a stream of material into the mediastinum and often the pleural cavity as well. The condition was first identified by Boerhaave, who reported the case of a grand admiral of the Dutch fleet who was a glutton and practised autoemesis. Boerhaave’s syndrome is the most serious type of perforation because of the large volume of material that is released under pressure. This causes rapid chemical irritation in the mediastinum and pleura followed by infection if untreated. Barotrauma has also been described in relation to other pressure events when the patient strains against a closed glottis (e.g. defecation, labour, weight-lifting).
What is Mackler's triad
Meckler's triad consists of the clinical symptoms of vomiting, followed by severe pain in the chest, usually retrosternal, lower thoracic, and upper abdominal, associated with subcutaneous emphysema detected on physical examination
👉 esophageal rupture (Boerhaave syndrome)
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