Discussion
Our patient experienced a perforation from the hypopharynx to the aortic
arch. Based off of the patient history, we postulate that the esophageal
perforation that occurred was a result of an increase in pressure due to
patient activity. According to the patient, she had been yelling at her
significant other for quite some time, with no other voice-related
activity. She had not swallowed any sharp objects. She had no previous
esophageal disease.
With no episodes of vomiting or ingestion of a foreign body recorded
prior to the esophageal rupture, combined with a chest x-ray showing no
pneumoperitoneum and no subcutaneous emphysema, Boerrhave’s syndrome was
ruled out Thus her diagnosis of esophageal perforation was delayed for a
few days.
Spontaneous rupture of the esophagus as seen in Boerhaave’s syndrome
perforation commonly occurs in the lower one-third of esophagus. Our
patient had spontaneous rupture in the hypopharynx and cervical
esophagus.
While Boerhaave’s syndrome involves a full thickness perforation, our
patient experienced violation of the innermost mucosa, submucosa, and
muscularis propria of the esophagus. The adventitia remained intact.
This resulted in the perforation appearing as a walled off abscess on
CT.
Iatrogenic perforations
of the esophagus most frequently occur in the cervical esophagus just
above the upper sphincter, whereas spontaneous rupture as seen in
Boerhaave’s syndrome perforation commonly occurs in the lower one-third
of esophagus. Our patient had mild symptoms of esophageal perforation
prior to her laryngoscopy. Therefore, we feel that she likely had a
contained cervical esophageal perforation initially prior to her
laryngoscopy and did not experience the perforation from laryngoscopy.