This could be considered a bad street food experience. A 59-year-old previously healthy man had eaten some street food when something came up—like all the stuff that was in his stomach. Apparently, he literally couldn’t stomach the food and vomited it up quite forcefully. In fact, the vomiting was so forceful that it blew a hole in his esophagus, as described by a case report in the New England Journal of Medicine. And such a wretched retching situation is a medical emergency, because you are not exactly whole with a hole in your esophagus.
The Man Had Boerhaave Syndrome, Spontaneous Rupture Of The Esophagus
This was an example of Boerhaave syndrome, a rather rare life-threatening situation where your esophagus spontaneous ruptures from severe vomiting. Only an estimated 0.0003% of the population has suffered such an emergency. So, it’s probably something that you don’t want to make up as an excuse for missing work.
The man began suffering severe chest pain half an hour after he had vomited. These symptoms went on for five hours until he got to the emergency room at Qilu Hospital in Qingdao, China. Severe or repeated vomiting and sudden onset chest pain are two parts of what’s called the Mackler Triad, the trio of signs suggestive of Boerhaave syndrome. The third sign is subcutaneous emphysema, a fancy medical term for having air trapped in the tissues under your skin where it isn’t supposed to be. Penghui Wei, M.D., and Wenyong Zhu, M.D. of the Cheeloo College of Medicine at Shandong University described in the case report what happened next.
At the ER, the doctors found his breathing to be rapid and shallow and signs of air in his neck tissue, which, voilà, would constitute the third sign of the Mackler triad. A CT (computed tomography) of his chest indeed revealed a tear in his esophagus, along with air in the parts of his chest and neck where it shouldn’t be. The doctors then inserted a tube in his chest to drain the accumulated fluid and air. An esophagram, which is where you swallow contrast materials and then undergo X-rays to view the esophagus, confirmed the perforation of the esophagus.
Surgical Repair Of The Esophagus Was Needed
Since such a tear won’t heal on itself or with supplements, vaginal steaming or some kind of scented candle, the man underwent emergency surgery through thoracoscopy to repair the esophagus. Survival from Boerhaave syndrome really depends on how quickly you get treatment. The Cleveland Clinic website estimates that when treatment occurs within 24 hours, the survival rate is around 75%. This goes below 50% if you wait for more than 24 hours. In fact, once you get beyond 48 hours, the death rate reaches 90%.
This resulted in a 35-day stay in the hospital. He had to use a feeding tube through his nose to get nutrition for several months until imaging showed that his esophagus had adequately healed. Therefore, the man apparently got through what must have been a harrowing street food experience. But all of this does offer some food for thought.
Vomiting Can Cause Other Types Of Damage To Your Esophagus
Vomiting in general is not a good thing. The force of having your stomach contents being shot up into your esophagus can cause various degrees of damage to your esophagus. So can the acid that should normally stay in your stomach. Less severe than Boerhaave syndrome is a Mallory-Weiss tear, which is a tear in the lining of the esophagus, most often close to the stomach.
Signs of such damage include chest pain and blood in the vomit, known as hematemesis. You may also notice black tarry stools if the blood makes it down through your poop. On the other hand, there may not be any noticeable symptoms even when your esophagus has suffered significant damage. So if you find yourself repeatedly vomiting over time for whatever reason, it may be a good idea to check in with a doctor.
Again, Boerhaave syndrome is quite rare, which is why it is a case study in the New England Journal of Medicine. Such a journal wouldn’t have the following as a case study: man consumes street food, has diarrhea, the end. So don’t go around being petrified of having your esophagus rupture someday. But you may want to be careful of what you eat where and recognize the other bad things that could come up when you upchuck.
