Esophageal Rupture Location and Characteristics in Boerhaave Syndrome

Anatomical Location and Mechanism

The tear in Boerhaave syndrome is typically located on the left border of the lower third of the thoracic esophagus, with a characteristically large wall defect (3–8 cm), according to the World Journal of Emergency Surgery guidelines 1
Boerhaave syndrome results from an abrupt increase in esophageal pressure following forceful vomiting in the absence of relaxation of the upper esophageal sphincter, affecting the distal esophagus where the wall is anatomically weaker on the posterolateral aspect 1

The left-sided location of the tear typically causes contamination of the left thorax with air and digestive contents, as reported by the World Journal of Emergency Surgery 1
Mortality ranges between 10-20%, with delay in treatment being the most important survival predictor, highlighting the need for prompt diagnosis and management, as emphasized by the World Journal of Emergency Surgery 1, 3

Boerhaave syndrome differs from other esophageal perforations in that the tear is usually multiple small partial tears or tissue plane dissections rather than a single massive tear, with limited extravasation, as distinguished by Gut guidelines 4