What Causes Boerhaave’s Syndrome?

Trauma To the Abdomen

In rare cases, Boerhaave's syndrome may be caused by certain types of trauma to the abdomen. A case of Boerhaave's syndrome was reported where an individual experienced an esophageal rupture due to the impact on the body from a high elevation fall. Another example of trauma-induced Boerhaave's syndrome is where a heavy object fell on top of an individual's chest and abdominal cavity. In addition, cases of Boerhaave's syndrome have occurred where an individual was hit with an automobile as a pedestrian. Another common cause of trauma that results in Boerhaave's syndrome are injuries sustained from an explosion or blast. A gunshot wound or sharp object penetration of the upper abdominal area of an individual can cause the esophagus to perforate completely. The exact mechanism of how non-penetrative abdominal trauma causes the patient's esophagus to rupture remains unclear, but it is thought the esophagogastric sphincter remaining closed during impact is a key factor. When this sphincter remains closed, an influx of pressurized air to pushes on the cricopharyngeal sphincter and causes the esophagus to perforate.

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Weight Lifting

Some individuals may experience a tear of the esophagus as a result of heavy weight lifting activity. This can be from lifting heavy objects such as furniture during a move, or it could be attributed to the sport of weight lifting. Weight lifting as a sport involves the activity of an individual lifting weighted barbells in a single-movement lift from the floor to shoulder position. Sometimes the barbells are lifted from the shoulder position to the extended position above an individual's head. Should an internal mechanism cause the individual's esophagogastric sphincter to stay in a closed position during the weight lifting exercise, it is possible for the individual to experience tearing in their esophagus. The exercise of weight lifting or lifting of a heavy object can cause the abdominal muscles to contract and push air upwards towards the esophagus. When an influx of pressurized air is pushed into the esophagus, and the esophagogastric sphincter does not open to allow its release, the esophagus will dilate. If this dilation reaches a certain threshold, the patient's esophagus will perforate under pressure.

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