Rare Presentation of Boerhaave's Syndrome – A Tale of the Unexpected.

The case is described of a patient presenting with signs and symptoms of a large bowel obstruction with perforation, who at laparotomy was found to have caecal volvulus but no obvious cause for the air under the diaphragm. On dissection of the lesser sac, he was found to have an oesophageal perforation secondary to vomiting caused by the volvulus. This was repaired over a t-tube and despite delayed presentation, he made a full recovery. This cause of Boerhaave's syndrome has not previously been described, and underlines the need for careful search for the cause of air under the diaphragm when the laparotomy findings do not reveal an obvious perforation.