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.