What is the most common cause of Boerhaave syndrome?

• A. Esophagogastroduodenoscopy (EGD)
• B. Hernia
• C. Adhesions
• D. Acute mesenteric ischemia

Answer: (A)

Boerhaave syndrome is characterized by a spontaneous rupture of the esophagus, typically as a result of severe vomiting that increases intra-esophageal pressure. Among the options provided, esophagogastroduodenoscopy (EGD) is the most recognized procedural cause of Boerhaave syndrome. When EGD is poorly executed or if there is excessive manipulation of the esophagus, it can lead to a tear.

This condition is distinct due to its clinical presentation of severe chest pain, followed by mediastinal signs such as subcutaneous emphysema, and it is critical to identify and manage it promptly due to the risk of sepsis from the leakage of esophageal contents into the thoracic cavity.

Other options, such as hernia, adhesions, and acute mesenteric ischemia, are not associated with Boerhaave syndrome. Hernias can cause gastrointestinal issues, but they do not typically lead to the spontaneous rupture of the esophagus. Adhesions usually affect the intestines rather than causing rupture of the esophagus. Acute mesenteric ischemia involves blood flow obstruction to the intestines, which is unrelated to esophageal rupture. Understanding the context of these conditions helps clarify why EGD is recognized as the most common cause of this syndrome