Hamman and Boerhaave syndromes - diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

Scott Med J. 2014 Nov;59(4):e12-6. doi: 10.1177/0036933014556051. Epub 2014 Oct 22.

Abstract

Introduction: Hyperemesis gravidarum describes persistent vomiting leading to fluid and electrolyte imbalance. It is the commonest reason for admission in the first half of pregnancy. We describe a case of Hamman syndrome secondary to hyperemesis gravidarum. We also discuss Boerhaave syndrome: a particularly rare condition with only a handful of cases being described in the literature.

Case presentation: A 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph. She was treated conservatively for potential ruptured oesophagus but then self-discharged against medical advice.

Conclusion: Subcutaneous emphysema is an alarming finding in any pregnancy and should be treated in a timely and cautious manner. This case report adds weight to the previous literature advocating a conservative versus surgical approach to the management of a woman with Hamman syndrome secondary to hyperemesis gravidarum.

Keywords: Boerhaave syndrome; Hamman syndrome; Hyperemesis gravidarum; subcutaneous emphysema.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Ulcer Agents / administration & dosage
  • Antiemetics / administration & dosage
  • Chest Pain / etiology*
  • Cocaine-Related Disorders / complications*
  • Esophageal Diseases
  • Esophageal Perforation / diagnosis*
  • Esophageal Perforation / drug therapy
  • Esophageal Perforation / etiology*
  • Esophageal Perforation / physiopathology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fluid Therapy / methods
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Humans
  • Hyperemesis Gravidarum / complications*
  • Hyperemesis Gravidarum / drug therapy
  • Hyperemesis Gravidarum / physiopathology
  • Mediastinal Diseases / diagnosis*
  • Mediastinal Diseases / drug therapy
  • Mediastinal Diseases / etiology*
  • Mediastinal Diseases / physiopathology
  • Pregnancy
  • Ranitidine / administration & dosage
  • Rupture, Spontaneous
  • Spontaneous Perforation
  • Stockings, Compression
  • Subcutaneous Emphysema / drug therapy
  • Subcutaneous Emphysema / etiology*
  • Subcutaneous Emphysema / physiopathology

Substances

  • Anti-Ulcer Agents
  • Antiemetics
  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Ranitidine

Supplementary concepts

  • Boerhaave syndrome