The most common location of Boerhaave syndrome

Q: What is the most common location of esophageal perforation in Boerhaave syndrome? 


 Answer: The left posterolateral aspect of the distal esophagus

Although Boerhaave syndrome can occur in any patient but it should led physician to think of previously underlying undiagnosed conditions like eosinophilic esophagitis, Barrett's esophagus, infectious ulcers or non-infectious ulcers from pills/other objects. 

Without any underlying pathology, other possible causes of esophageal perforation in Boerhaave syndrome are usually due to "sudden increase in intraesophageal pressure combined with negative intrathoracic pressure" and include severe straining (defecation in constipation, weightlifting), vomiting, childbirth, seizure, forceful coughing or laughing, and others. Perforation is mostly a longitudinal esophageal tear at the left posterolateral aspect of the distal esophagus.

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References:

1. Pate JW, Walker WA, Cole FH Jr, et al. Spontaneous rupture of the esophagus: a 30-year experience. 

2. Ann Thorac Surg 1989; 47:689. Herbella FA, Matone J, Del Grande JC. Eponyms in esophageal surgery, part 2. Dis Esophagus 2005; 18:4.