Painless esophageal rupture in the second stage of labor presenting as surgical emphysema of the neck: a case report.

BACKGROUND: Pneumomediastinum in pregnancy has been described in around 200 cases, with an incidence of 1:100,000 pregnancies. The etiology is presumed to be either alveolar barotrauma secondary to the Valsalva maneuver (Hamman's syndrome) during the second stage of labor, or spontaneous esophageal rupture (Boerhaave's syndrome). The latter has a much higher morbidity/mortality and classically arises from esophageal rupture during excessive vomiting. Boerhaave's syndrome is described as a triad of chest pain, vomiting, and surgical emphysema, though all symptoms are seen in only one-third of cases. The majority of reported obstetric cases originate from vomiting in early pregnancy with patients clinically unwell, presenting with acute severe chest pain and shortness of breath.

CASE PRESENTATION: We present a case of esophageal rupture in a 24-year-old Eastern European primigravida, presenting postnatally with neck emphysema in the absence of significant chest pain or other symptoms.

CONCLUSION: The diagnosis of Boerhaave's syndrome is often delayed, and a high index of clinical suspicion is required to reach a timely diagnosis.