Mackler triad

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The Mackler triad is a term that defines the classical presentation seen in Boerhaave syndrome. It comprises:

1. Vomiting
2. Lower chest pain
3. Subcutaneous emphysema

Subcutaneous emphysema is only seen in approximately half of patients at the initial presentation (typically in those patients who present later).

WORST EXPERIENCE OF MY LIFE

On 11.FEB.2010, I ruptured my esophagus due to vomitting brought on by a stomach virus. I had been in the medical field, mostly as the Interventional Radiology and Vascular Imaging Department Director, for nearly 20 years. I had only seen it one time. I was on the phone with a co-worker when it happened. First time I vomitted, it felt like I got stabbed in my lower left chest. The second time was much worse. My rupture was extremely rare (2%-5%) due to the fact that I had no contributing factors. It was the physiology of vomitting that caused mine. It was "The Perfect Storm". Initially, negative intrathoracic pressure is created by wretching. As the vomit goes up it creates positive pressure in the esophagus. If the crico-pharangeal muscle does not relax, the pressure in the esophagus rises dramatically and the esophagus ruptures at its weakest point, the lower postero-lateral section. I knew it was ruptured before the EMS arrived. The pain was so severe that, at that moment, I wanted to die. I was intubated and bilateral chest tubes were placed. I was on the vent in the ICU for a month. I had 80% of my esophagus removed. Remainder of it was diverted to an ostomy bag below my left clavicle. Developed an empyema. Coded twice. Two more major surgeries and at least 24 dilitations and stent placements. My insurance claim is well over $800,000. In short..............it sucked!

Rare but you're not alone

I'm a 2 time survivor from vomiting induced Boerhaave Syndrome.
It's a life changing event that can light a fire under you to help others.
Any questions about this I would be honored to help answer or even offer myself as a test subject.
Our intestines are made of bio-organic compounds, the same as goats milk. Our bones are made of calcium, same as cows milk.
Did you ever notice how goats bounce from the minute they're born until they die of old age? That's because being bio-organic based means they won't suffer from arthritis or other calcium derived problems. Secondly it's the closest thing to human mothers milk.

Since you are what you eat I encourage you to try using goats milk to help rebuild and heal faster. Lettuce was hard for me to digest after being hospitalized, but spinach was not.

If I can help in anyway please contact me.
Derek 480.440.4486

Boerhaave syndrome

boerhaave syndrome is a complication of malorry weiss tear. this syndrome is characterized by oesophageal rupture with associated mediastinitis.

sorry bro..correct me if i am wrong

i thought boerhaave syndrome was idiopathic spontaneous rupture.
is it secondary to mallory weiss tear??

mallory weiss tear is subcutaneous vessel repture in the fundus resulting rarely in massive hemetemesis. how is it related to oesophageal rupture

and most common site of rupture in boerhaave syndrome is lower third left postero lateral
of oesophagus

subcutaneous!

I use to know that 'subcutaneous' relates to d skin. why relate to the fundus here? I guess you mean 'submucosal'.

I agree bro

Yes u r right in stating that both of them are different entities .though both can be caused by Severe vomiting or retching, boerhaave can also be caused by instrumentation.and yes it is spontaneous rupture of esophagus but site may vary as per the cause.posterolateral wal is for instrumentation induced rupture.also u r right about Mallory Weiss tear which is most common at the fundus.

Boerhaave Syndrome.....sufferer

I had two complete Boerhaave tears in 2010 both due to violent uncontrollable vomiting. There wasn't any sign of blood in the vomit for either of my episodes. First time vomiting lasted about 6 hours before I called for help. Once in the ER I was shaking uncontrollably, fever was off the charts, pale, my body was trying to vomit but couldn't, extremely dehydrated all I wanted was water.
It felt very similar to the heat stroke I had in 2007 or 08.

They didn't know what to do or what was wrong. I had subcutaneous air around my heart, pleural cavities, around my esophagus and all across the surface of my skin around my chest and shoulders.
My tear was never discovered even after the second tear. I've been scoped from both ends with no sign of scar tissue or tear. Sampling of tissues and stomach acid hasn't provided any solutions.

They had me swallow Barium while rotating and scanning my esophagus again with no evidence of the tear. Due to the lack of knowledge they waited a few days before having me swallow the Barium.
If there is any way I can help with the research for future sufferers please don't hesitate to contact me.
Derek 480.440.4486

Boerhaave's Syndrome (x2)

First, let me say that anyone who has ever ruptured his esophagus and survived is a walking miracle. What type of intervention was used for your first rupture? Chest tubes? The reason I ask is that an untreated Boerhaave's rupture is nearly 100%. You may have had a Mallory-Weiss tear which can heal itself. Did they surgically repair it or place a covered stent? Were you scoped for the first one? Air in the mediastinum is very serious and is indicative of the rupture of an air filled structure within the mediastinum. Given your symptoms, Radiologic findings, and clinical presentation, Boerhaave's should have been near the top of the differential diagnosis.

diagnosis

I'm confused, if the tear was never discovered even after the second tear, how do you know it was there? Where were you treated? Can I contact your doctor?

Not impossible.....but damn close!!

I have to agree with you. I find it extremely odd that a Boerhaave's rupture of the esophagus could not be diagnosed on two seperate occasions. Maybe Mallory-Weiss tear but not a Boerhaave's rupture. Boerhaave's Syndrome is widely known as the most horrific and deadly injury of the digestive system. I would love to hear the breakdown of his experiences, because based on my own Boerhaave's rupture.....it's damn near impossible.