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The medical condition is rare and life-threatening.
Credit: Getty | Creative-Family
Food poisoning is never fun—and a lot of the time, it can seem quite forceful. Take the common gut-buster norovirus for example. It can ignite forces that might make jet propulsion researchers jealous. Victims may fear liftoff from a porcelain launch pad, or a vomitous blast with a reverse thrust that seems powerful enough to drop a military jet from the sky.
But then there are the rare illnesses that produce truly violent forces. Such was the case for one unfortunate man in China who made the near-fatal decision to eat some dubious street food.
It's unclear what the 59-year-old ate exactly—but it's a safe bet he'll never eat it again. Soon after, his innards vigorously ignited. According to a case report in this week's issue of the New England Journal of Medicine, the man, in fact, vomited with so much explosive force that he blew apart his esophagus—the muscular tube through which food passes from the throat to the stomach.
The rare condition is called Boerhaave syndrome, defined as a life-threatening, spontaneous rupture of the esophagus typically caused by severe vomiting or retching. If the condition isn't treated quickly enough (within 12 to 24 hours), the mortality rate can range from 60 percent to 100 percent.
According to two doctors who treated the man in the Qilu Hospital of Shandong University in Qingdao—doctors Penghui Wei and Wenyong Zhu—the man arrived in the emergency department five and a half hours after the offending food fueled his internal combustion. He was experiencing severe chest pain while inhaling and exhaling.
Bilious blowout
Doctors noted that his breath was fast and shallow, with crackling in his neck. But breathing sounds from the base of his right lung were quiet. A computed tomography (CT) scan revealed the problems. There was air in his chest space and into his neck. Fluid was also building up around his lungs, and his right lung was collapsing. The scan also showed a perforation in the esophagus.
The doctors inserted a chest tube to remove the fluid, which did not include gastric contents, suggesting the fluid build-up was from chest inflammation.
The doctors then did an additional X-ray exam of the esophagus using a water-soluble contrast agent. This clearly revealed a large gash in the man's esophagus resulting from the robust eruption. The imaging also showed the contrast agent leaking out into the man's chest.
The doctors quickly sent the man into emergency surgery to repair his esophagus. He spent the next 35 days in the hospital recovering. When he was discharged, he still had a feeding tube that passed through his nose and into his small intestine. It took an additional three months for the perforation to completely heal, at which point doctors could finally remove the feeding tube.
It's not entirely clear what causes Boerhaave syndrome. Researchers hypothesize that it occurs from a loss of neuromuscular coordination, which, in particular, causes the upper sphincter in the esophagus—the cricopharyngeus—to fail to relax at the onset of vomiting. The rapid rise of internal pressure overwhelms the esophagus, typically causing a lengthwise tear in the lower third of the tube, which is the weakest portion. On average, tears can be up to 8 centimeters (about 3 inches) long.
Though researchers expect that cases are underreported, the estimated incidence based on reports is about three cases per million people globally each year.
Credit: Getty | Creative-Family
Food poisoning is never fun—and a lot of the time, it can seem quite forceful. Take the common gut-buster norovirus for example. It can ignite forces that might make jet propulsion researchers jealous. Victims may fear liftoff from a porcelain launch pad, or a vomitous blast with a reverse thrust that seems powerful enough to drop a military jet from the sky.
But then there are the rare illnesses that produce truly violent forces. Such was the case for one unfortunate man in China who made the near-fatal decision to eat some dubious street food.
It's unclear what the 59-year-old ate exactly—but it's a safe bet he'll never eat it again. Soon after, his innards vigorously ignited. According to a case report in this week's issue of the New England Journal of Medicine, the man, in fact, vomited with so much explosive force that he blew apart his esophagus—the muscular tube through which food passes from the throat to the stomach.
The rare condition is called Boerhaave syndrome, defined as a life-threatening, spontaneous rupture of the esophagus typically caused by severe vomiting or retching. If the condition isn't treated quickly enough (within 12 to 24 hours), the mortality rate can range from 60 percent to 100 percent.
According to two doctors who treated the man in the Qilu Hospital of Shandong University in Qingdao—doctors Penghui Wei and Wenyong Zhu—the man arrived in the emergency department five and a half hours after the offending food fueled his internal combustion. He was experiencing severe chest pain while inhaling and exhaling.
Bilious blowout
Doctors noted that his breath was fast and shallow, with crackling in his neck. But breathing sounds from the base of his right lung were quiet. A computed tomography (CT) scan revealed the problems. There was air in his chest space and into his neck. Fluid was also building up around his lungs, and his right lung was collapsing. The scan also showed a perforation in the esophagus.
The doctors inserted a chest tube to remove the fluid, which did not include gastric contents, suggesting the fluid build-up was from chest inflammation.
The doctors then did an additional X-ray exam of the esophagus using a water-soluble contrast agent. This clearly revealed a large gash in the man's esophagus resulting from the robust eruption. The imaging also showed the contrast agent leaking out into the man's chest.
The doctors quickly sent the man into emergency surgery to repair his esophagus. He spent the next 35 days in the hospital recovering. When he was discharged, he still had a feeding tube that passed through his nose and into his small intestine. It took an additional three months for the perforation to completely heal, at which point doctors could finally remove the feeding tube.
It's not entirely clear what causes Boerhaave syndrome. Researchers hypothesize that it occurs from a loss of neuromuscular coordination, which, in particular, causes the upper sphincter in the esophagus—the cricopharyngeus—to fail to relax at the onset of vomiting. The rapid rise of internal pressure overwhelms the esophagus, typically causing a lengthwise tear in the lower third of the tube, which is the weakest portion. On average, tears can be up to 8 centimeters (about 3 inches) long.
Though researchers expect that cases are underreported, the estimated incidence based on reports is about three cases per million people globally each year.
