Delayed and atypical presentation of Boerhaave's syndrome as epigastric mass

Boerhaave's syndrome (BS), also known as “spontaneous rupture of the esophagus,” is an emergent condition requiring early diagnosis and management to prevent associated morbidity and mortality. Mortality ranges between 20% and 40% with timely treatment but this rises to virtually 100% if treatment is delayed by more than 48 h.[1] The classical clinical triad of vomiting, chest pain, and subcutaneous emphysema classically described symptoms for BS, which is actually uncommon accounting for the frequently delayed diagnosis.[2] This article describes a case of this syndrome in which the actual diagnosis was made 1 month after the esophageal perforation because of delayed atypical presentation with epigastrium mass and was successfully managed.