Question:medium
A patient presents with epigastric pain after a heavy meal. On examination there is tenderness and rigidity in the upper abdomen, and the chest X-ray shows pneumomediastinum. The most likely cause is:
A patient presents with epigastric pain after a heavy meal. On examination there is tenderness and rigidity in the upper abdomen, and the chest X-ray shows pneumomediastinum. The most likely cause is:
Show Hint
Vomiting then chest pain then air in the mediastinum points to which named syndrome?
Updated On: Jun 23, 2026
- Spontaneous oesophageal rupture (Boerhaave syndrome)
- Penetrating foreign body injury to the oesophagus
- Perforated peptic ulcer
- Rupture of an emphysematous bulla
Show Solution
The Correct Option is A
Solution and Explanation
Pattern-spotting on the X-ray. Let the air location tell the story. Free air UNDER the diaphragm means a hollow viscus like a peptic ulcer has perforated; air in the MEDIASTINUM means the oesophagus has torn. This patient shows pneumomediastinum, so the leak is oesophageal.
Confirm with the triad: Boerhaave syndrome runs as vomiting, then chest pain, then surgical (subcutaneous) emphysema, the Mackler triad, with the V sign of Naclerio on the film. The trigger of a heavy meal followed by retching fits perfectly.
Eliminate: no foreign body was swallowed; a perforated ulcer would give pneumoperitoneum, not pneumomediastinum; a ruptured bulla gives a pneumothorax in a COPD patient. So the answer is spontaneous oesophageal rupture. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018; SRB's Manual of Surgery, 4th edition.
Confirm with the triad: Boerhaave syndrome runs as vomiting, then chest pain, then surgical (subcutaneous) emphysema, the Mackler triad, with the V sign of Naclerio on the film. The trigger of a heavy meal followed by retching fits perfectly.
Eliminate: no foreign body was swallowed; a perforated ulcer would give pneumoperitoneum, not pneumomediastinum; a ruptured bulla gives a pneumothorax in a COPD patient. So the answer is spontaneous oesophageal rupture. Ref: Bailey and Love, Short Practice of Surgery, 27th edition, 2018; SRB's Manual of Surgery, 4th edition.
Was this answer helpful?
0
