UNASSIGNED: A 47-year-old @entity1 was attended at the emergency room for severe @entity662 after eating sausage with subsequent @entity391 and mild @entity360 . In the chest radiography we could not see abnormalities. He referred previous episodes of @entity1224 without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with @entity2910 or @entity3253 in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction. @entity1625 ( @entity1625 ) confirmed a perforation of the lower esophagus, with pneumothorax and cervical and @entity764 . Surgical treatment was indicated: esophageal suture, myotomy and gastric fundoplication. The @entity1 presented good evolution. @entity3253 is a rare syndrome, but with high mortality (35%). Mackler triad is very characteristic: @entity391 , @entity158 and cervical @entity9285 ; but it occurs rarely. Chest radiography is useful, showing abnormalities in up to 90% of @entity1 . The differential diagnosis includes @entity74 : @entity583 , @entity5229 , @entity2396 or @entity55 . The role of endoscopy is small, mainly limited to prosthesis placement in high-risk surgical @entity1 . In our case the chest radiograph was initially normal, probably related to @entity3355 and, in presence of @entity360 , gastroscopy was performed which allowed us to early diagnosis and treatment.

XXXX : diagnostic gastroscopy.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'man'] @entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain'] @entity1625 :: ('MESH:D004828', 'Disease') :: ['Thoracic-abdominal computed tomography', 'TC'] @entity9285 :: ('MESH:D013352', 'Disease') :: ['subcutaneous emphysema'] @entity5229 :: ('MESH:D011030', 'Disease') :: ['spontaneous pneumothorax'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity3355 :: ('MESH:D014095', 'Disease') :: ['bolus impaction'] @entity2910 :: ('MESH:D004941', 'Disease') :: ['esophageal rupture'] @entity391 :: ('MESH:D014839', 'Disease') :: ['vomiting'] @entity2396 :: ('MESH:D010493', 'Disease') :: ['pericarditis'] @entity3253 :: ('MESH:C536571', 'Disease') :: ["Boerhaave's syndrome"] @entity764 :: ('MESH:D013898', 'Disease') :: ['chest emphysema'] @entity74 :: ('MESH:D030342', 'Disease') :: ['cardiorespiratory disorders'] @entity158 :: ('MESH:D010146', 'Disease') :: ['retrosternal pain'] @entity583 :: ('MESH:D009203', 'Disease') :: ['acute myocardial infarction'] @entity360 :: ('MESH:D006471', 'Disease') :: ['upper gastrointestinal bleeding'] @entity1224 :: ('MESH:D000402', 'Disease') :: ['choking']
@entity3253 :: (MESH:C536571,Disease) :: ['Boerhaave's syndrome']
