Spontaneous esophageal rupture (Boerhaave's syndrome). An uncommon image.

A 76-year-old man was found lay down on the floor. After an acute alcohol intake he started vomiting. In the Emergency Room he was disoriented with lividity. Vital observation revealed low blood pressure and tachycardia, subcutaneous emphysema and basal rales on auscultation. Chest radiography with shadowing in the left lower zone. A water-soluble contrast esophagogram (Gastrograffin) revealed the location and extent of extravasation of contrast material in upper mediastinum (Fig. 1). With a high degree of clinical suspicion of Boerhaave’s syndrome, it was decided surgical intervention. Prior surgery, we performed an upper endoscopy that showed two ruptures in the esophageal wall with necrosis and dark fluid (Figs. 2 and 3). The patient underwent surgery, during which it was found that there was mediastinitis and three esophageal perforations, two small in the back wall and another of 10 cm long in the side wall of middle third esophagus. Transhiatal esophagectomy with cervical esophagostomy was performed with a favorable evolution.