In case of iatrogenic perforation common site is cervical esophagus just above the upper sphincter whereas spontaneous rupture as seen in Boerhaaves syndrome perforation commonly occurs in the lower one-third of esophagus. Signs and symptoms
The classic history of esophageal rupture is one of severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock develop rapidly thereafter.Physical examination is usually not helpful, particularly early in the course. Subcutaneous emphysema (crepitation) is an important diagnostic finding but is not very sensitive, being present in only 9 of 34 patients (27 percent) in one series. A pleural effusion may be detected.Macklers triad includes chest pain, vomiting, and subcutaneous emphysema, and while it is a classical presentation, it is only present in 14% of people.Pain can occasionally radiate to the left shoulder, causing physicians to confuse an esophageal perforation with a myocardial infarction.It may also be audibly recognized as Hammans sign. Pathophysiology
Esophageal rupture,  in Boerhaave syndrome, is thought to be the result of a sudden rise in internal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle (a sphincter within the pharynx) to relax. As the intra-oesophageal pressure increases, the bolus within the oesophagus has nowhere to go superiorly (as the cricopharyngeus fails to relax) which causes the oesophagus to rupture.
doi:10.1016/j.jemermed.2016.05.061. PMID 27693067. Henderson, John A.M.; Péloquin, AndréJ.M. (1989). "Boerhaave revisited: Spontaneous esophageal perforation as a diagnostic masquerader". The American Journal of Medicine. 86 (5): 559–67. doi:10.1016/0002-9343(89)90385-9. PMID 2653030. Larrieu, AJ; Kieffer, R (1975). "Boerhaave syndrome: report of a case treated non-operatively". Annals of Surgery. 181 (4): 452–4. doi:10.1097/00000658-197504000-00015. PMC 1343787. PMID 1130863. Patton, Anthony S.; Lawson, Dexter W.; Shannon, James M.; Risley, Thomas S.; Bixby, Frank E. (1979). "Reevaluation of the Boerhaave syndrome". The American Journal of Surgery. 137 (4): 560–5. doi:10.1016/0002-9610(79)90131-4. PMID 426207. Ivey, Tom D.; Simonowitz, David A.; Dillard, David H.; Miller, Donald W. (1981). "Boerhaave syndrome". The American Journal of Surgery. 141 (5): 531–3. doi:10.1016/0002-9610(81)90040-4. PMID 6784584. == External links ==