Xiong SY, Liu CJ, Li YF, Zhang HL, Chen XW, Wang HM, Chen JC. Multimodal diagnostic and surgical approach to spontaneous esophageal rupture induced by severe coughing: A case report. World J Gastrointest Surg 2025; 17(4): 101578 [DOI: 10.4240/wjgs.v17.i4.101578]
Corresponding Author of This Article
Ji-Cai Chen, MM, Associate Chief Physician, Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. chenjicai1980@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shu-Yun Xiong, Chang-Jiang Liu, Yong-Feng Li, Xiao-Wei Chen, Hai-Man Wang, Ji-Cai Chen, Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Han-Liang Zhang, Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Author contributions: Xiong SY and Liu CJ conceived and designed the study; Li YF, Zhang HL, and Chen XW performed the experiments; Wang HM analyzed the data; Chen JC wrote the manuscript; All authors reviewed and approved the final version of the manuscript.
Supported by Guangzhou Municipal Science and Technology Bureau, No. SL2024AD3JD0112.
Informed consent statement: Informed consent was obtained from all individual participants included in the study or their legal guardians. This statement ensures compliance with ethical standards and confirms that informed consent was obtained from all participants or their legal guardians.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Cai Chen, MM, Associate Chief Physician, Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, No. 111 Dade Road, Guangzhou 510120, Guangdong Province, China. chenjicai1980@126.com
Received: September 19, 2024 Revised: December 10, 2024 Accepted: February 10, 2025 Published online: April 27, 2025 Processing time: 190 Days and 18.4 Hours
Abstract
BACKGROUND
Boerhaave syndrome, or spontaneous esophageal rupture, is a rare and life-threatening emergency, typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting. Early diagnosis is challenging as its symptoms often resemble those of other diseases. Understanding its pathological features and treatment strategies is therefore critical for clinical practice.
CASE SUMMARY
This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension. Following severe coughing, the patient developed chest pain, vomiting, and respiratory distress. Initial clinical evaluation was inconclusive, with a suspected diagnosis of cardiovascular or gastrointestinal conditions. After further examination, the diagnosis of spontaneous esophageal rupture was confirmed. Chest X-ray, computed tomography, and endoscopy revealed a rupture in the lower esophagus, along with mediastinal abscess and pleural effusion. Laboratory tests showed mild infection markers. The patient underwent surgical repair of the esophageal rupture (approximately 3 cm in length) with mediastinal drainage. Postoperatively, the patient’s temperature normalized within 3 days, respiratory function improved, and pleural effusion significantly decreased. After two weeks of treatment, the patient was discharged without complications and had a favorable prognosis. The study suggests that while violent coughing is a rare trigger, it can lead to severe damage, and imaging techniques play a crucial role in diagnosis.
CONCLUSION
Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial for improving prognosis. This case highlights the importance of imaging and surgical treatment, offering new insights for managing similar cases and providing valuable clinical guidance.
Core Tip: This study thoroughly reveals the pathology of spontaneous esophageal rupture induced by severe coughing. It systematically documents the complete diagnostic and treatment process of esophageal rupture for the first time. Advanced imaging techniques are employed to accurately locate esophageal injuries. A personalized surgical strategy is implemented, significantly improving treatment success rates. The findings offer innovative strategies for managing similar rare cases.
