Indian Journal of Critical Care Case Report

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VOLUME 3 , ISSUE 1 ( January-February, 2024 ) > List of Articles


Mackler's Triad to Suspect Boerhaave's Syndrome

Archana Nair

Keywords : Boerhaave's syndrome, Case report, Esophageal rupture, Pneumomediastinum, Pneumothorax

Citation Information : Nair A. Mackler's Triad to Suspect Boerhaave's Syndrome. 2024; 3 (1):21-23.

DOI: 10.5005/jp-journals-11006-0088

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2024; The Author(s).


Background: A case report of esophageal perforation presenting with the rare symptom triad of vomiting, chest pain, and subcutaneous emphysema (Mackler's triad) and its diagnostic evaluation and management. Case description: A 60-year-old patient presented to the emergency department (ED) with a history of two episodes of vomiting, followed by the development of chest pain, abdominal pain, and respiratory distress. On evaluation, the patient was tachypneic, tachycardic, and hypoxic. Subcutaneous emphysema was present in the neck and upper chest. As bedside ultrasound revealed bilateral pneumothorax, chest tubes were inserted on both sides, and the patient was intubated for severe respiratory distress. Computed tomography (CT) chest was suggestive of pneumomediastinum with bilateral pneumothorax. Based on the clinical and radiological evidence, a diagnosis of Boerhaave's syndrome (BS) was made, and the patient was taken up for upper gastrointestinal endoscopy followed by exploratory laparotomy. Patient had a 3 cm long esophageal perforation in left lateral wall of lower esophagus near gastroesophageal junction. Despite aggressive management, patient succumbed on the seventh postoperative day. Boerhaave's syndrome (BS) is a potentially lethal condition that poses a major diagnostic and therapeutic challenge for the emergency physician. Spontaneous esophageal perforation presenting with the classical Mackler's triad, that is, vomiting, chest pain, and subcutaneous emphysema is rare. A high index of suspicion is needed for prompt diagnosis, which, in turn, paves the way for early and appropriate management.

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