The authors, Dr Hui Jern Loh and Mr David Cooke from Fremantle Hospital, present a rare case in which the rapid ingestion of a mouthful of cold carbonated drink led to a tear in a woman's oesophageal wall.
The woman suffered sudden chest pain and a brief loss of consciousness immediately after swallowing a large mouthful of a cold carbonate drink directly from the bottle. The pain felt worse on swallowing. The patient suffered mild nausea but no vomiting. She had a slightly increased temperature (37.6C) and a slightly raised white blood cell count.
A CT scan revealed a tiny bubble of gas in or near the wall of the oesophagus, suggesting that the woman's oesophagus had been perforated. A gastroscopy revealed a 10 cm tear (a partial perforation) in her oesophagus.
The patient was treated with a range of drugs and was discharged from hospital on Day 7. After four weeks she still felt discomfort when swallowing, but the tear had healed.
Spontaneous oesophageal perforation (Boerhaave's syndrome) — usually caused by forceful vomiting — is relatively uncommon, but potentially fatal in people who have complete perforation.
"Among people who experience complete perforation, mortality is 13-25 per cent if treated within 24 hours of symptom onset . . . and 89 per cent if treated after more than 48 hours", say the authors.
People who suffer from a range of digestive problems, including reflux oesophagitis, infectious oesophagitis or Barrett's ulceration, are at greater risk of developing Boerhaave's syndrome.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT Dr Hui Jern LOH 0402 883 910
Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471