Boerhaave syndrome

 It looks like you mean Boerhaave syndrome (often misspelled “Bowrheave”).

What it is

Boerhaave syndrome is a full-thickness tear of the oesophagus, usually caused by a sudden rise in pressure inside the esophagus—classically after forceful vomiting.

It’s a medical emergency because stomach contents leak into the chest → causing severe infection (mediastinitis).

Classic cause

• Repeated or forceful vomiting
• Often after heavy alcohol intake (“retching then rupture”)

Classic presentation (important exam triad)

• Sudden severe chest pain (often after vomiting)
• Vomiting or retching history
• Subcutaneous emphysema (air under skin → crackling sensation in neck/chest)

This triad is called Mackler’s triad, but it’s only present in a minority of cases.

Other symptoms

• Shortness of breath
• Fever (later)
• Rapid deterioration
• Tachycardia, shock if severe

Diagnosis (key tests)

1. CT chest with contrast (best initial test in many settings)
• Shows air and leak of contrast
2. Water-soluble contrast swallow (Gastrografin study)
• Shows site of perforation
3. Chest X-ray
• Mediastinal air, pleural effusion, pneumothorax

Management (emergency)

• NPO (nil by mouth)
• IV broad-spectrum antibiotics (cover gut flora)
• IV fluids, resuscitation
• Urgent surgical or endoscopic repair depending on timing/severity

Key distinction

• Boerhaave = full rupture (emergency, very dangerous)
• Mallory-Weiss tear = partial mucosal tear (bleeding, usually less severe)

If you want, I can also give:

• a quick exam comparison table (Boerhaave vs Mallory-Weiss vs esophageal perforation causes)
• or a 2-minute “how to spot it in A&E” checklist