A RARE ASSOCIATION OF BOERHAAVE'S SYNDROME WITH PNEUMATOSIS INTESTINALISA CASE REPORT

Abstract

Pneumatosis intestinalis (PI) is a rare condition which is characterized by multiple thin walled gaseous cysts in the bowel wall. Boerhaaves syndrome (rupture of  oesophagus following a bout of vomiting) as a cause in  association with pnuematosis intestinalis has not been  described in literature. We report a case of Boerhaaves  syndrome who had been seen at a private hospital following a bout of vomiting and with oesophageal rupture diagnosed by an endoscopy. He had been given bilateral ICD at the private hospital itself. He presented to the emergency department of CMCH two days later with the symptoms and signs of                intestinal obstruction and peritonitis. Laparotomy showed multiple subserosal blebs over the entire jejunum and ileum with grossly dilated bowel loops extending upto the splenic flexure of transverse colon. Diversion transverse colostomy with feeding jejunostomy was done. Since the patient was in shock and with mediastinitis , patient had to be managed conservatively for the oesophageal perforation. After a period of four weeks it was decided to do oesophageal stenting since there was no improvement of the patient. Stenting was   successfully done and the patient improved over the next two weeks. Subsequently patient developed progressive  mediastinitis and died due to cardio-respiratory  embarrassment. This is a rare occurrence of Boerhaaves syndrome with intestinal obstruction and pneumatosis  intestinalis. Although the patient succumbed to the                    complications of mediastinitis the case is presented for   its rarity.