Boerhaave'S Syndrome With Rupture Of The Right Wall Of The Esophagus After Oral Administration Of Sulfate Solution

A 63-year-old male took magnesium sulfate for bowel cleansing; subsequently, he developed severe nausea and vomiting, and then suffered from acute epigastric pain and compression pain in the right chest, with dyspnea, chest tightness and palpitation. Physical examination revealed subcutaneous emphysema in the neck, with crepitus, and diminished breathing sounds on the right side of the chest. A thoracic computed tomography (CT) scan showed mediastinal emphysema, right-sided pleural effusion and pneumothorax (Figure 1A). We highly suspected a diagnosis of Boerhaave's syndrome (BS), and endoscopy was performed immediately. During the process, a mucosal tear located in the right wall of the oesophagus that was 35 cm away from the incisors was seen (Figure 1B). As his general condition was poor, endoscopic repair technique was preferred, a total of 7 titanium clips were used for suturing the split (Figure 1C). A few days later, recheck chest CT scan showed major improvement compared to the previous imaging (Figure 1D); subsequently, esophageal angiography was performed and no contrast agent leakage was observed (Figure 1E).