Paramedics are bringing in a hypotensive gastrointestinal bleeder: An unexpected diagnosis

Timothy K. Ruttan, Arthur B Sanders

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Acute esophageal rupture is a rare emergency that must be diagnosed quickly and treated aggressively to avoid significant morbidity and mortality. The typical presentation of this disease includes chest pain, and the diagnosis is challenging when cardinal features such as this are absent. Objectives: This case report discusses an atypical presentation of esophageal rupture in a patient with a predisposing condition and highlights the diagnostic and cognitive difficulties involved in making the appropriate diagnosis. Case Report: We report a case of a 51-year-old woman who presented to the Emergency Department with hypotension and an emergency medical services report of hematemesis. The patient had a documented history of upper gastrointestinal bleeding and Zollinger-Ellison syndrome during her past hospitalizations; however, the patient was not anemic and had a negative stool guiac despite symptoms for 3 days. A subsequent chest radiograph led to the diagnosis of esophageal rupture with a bilateral pneumothorax requiring thoracostomies. She reported no chest pain. Conclusions: The esophageal rupture and subsequent hypotension was likely secondary to the combination of her Zollinger-Ellison syndrome and recent vomiting episodes. It is important to avoid premature diagnostic closure and think about unusual presentations of emergent conditions such as esophageal rupture.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
Volume43
Issue number4
DOIs
StatePublished - Oct 2012

Fingerprint

Allied Health Personnel
Rupture
Zollinger-Ellison Syndrome
Chest Pain
Hypotension
Thoracostomy
Hematemesis
Emergency Medical Services
Pneumothorax
Vomiting
Hospital Emergency Service
Hospitalization
Emergencies
Thorax
Hemorrhage
Morbidity
Mortality

Keywords

  • Boerhaave syndrome
  • esophageal rupture
  • pneumothorax
  • upper gastrointestinal bleeding
  • Zollinger-Ellison syndrome

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Paramedics are bringing in a hypotensive gastrointestinal bleeder : An unexpected diagnosis. / Ruttan, Timothy K.; Sanders, Arthur B.

In: Journal of Emergency Medicine, Vol. 43, No. 4, 10.2012.

Research output: Contribution to journalArticle

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