The admiral had a transverse tear, an event that rarely occurs. Boerhaave syndrome is a potentially devastating injury. This article discusses the causes, investigation, and initial therapy for this potentially lethal gastrointestinal perforation. Two distinct entities, esophageal rupture and esophageal perforation, are described. Thus, the wall is weaker and may rupture at a lower intraluminal pressure.
Vomiting usually precedes development of spontaneous perforation.
Tears usually are 0.6-8.9 cm long. Predilection for left-side perforations may be caused by lack of adjacent supporting structures, thinning of musculature in lower esophagus, and anterior angulation of esophagus at left diaphragmatic crus. Tears usually extend superiorly. Perforation of esophagus resulting from instrumentation or trauma does not appear to have a specific site predilection. All other cases of esophageal perforation are caused by foreign bodies or traumatic perforations.