Boerhaave's syndrome. Spontaneous formation of an esophageal-bronchial fistula.

Although Boerhaave's syndrome is usually a surgical emergency, we recently observed a 57-year-old man with a chronic Boerhaave's syndrome. Initially, he responded to conservative management. However, the spontaneous formation of an esophageal-bronchial fistula complicated his course. Pulmonary symptoms and weight loss prompted surgical intervention. We speculate that the patient's six-week clinical course before surgery was tolerated because the contamination of the mediastinum following the initial esophageal tear was well contained and allowed sufficient time for the spontaneous formation of an esophageal-bronchial fistula.