Boerhaave syndrome is best described as which?

• A. Full-thickness distal esophageal rupture
• B. Mallory-Weis tear
• C. Perforation of stomach
• D. Esophageal varice bleed

Answer: (A)

Boerhaave syndrome is a spontaneous, full-thickness rupture of the distal esophagus after forceful vomiting. This rupture allows contents to leak into the mediastinum and pleural space, causing severe chest pain, mediastinal infection (mediastinitis), and often rapid deterioration. The key feature is a rupture that goes through all layers of the esophageal wall, typically in the distal esophagus just above the diaphragm.

This contrasts with a Mallory-Weis tear, which is a mucosal tear at the gastroesophageal junction caused by retching and presents with hematemesis but not a full-thickness rupture. Perforation of the stomach is a gastric perforation, not esophageal, and esophageal varice bleed involves bleeding from dilated esophageal veins due to portal hypertension, not rupture of the esophagus itself.