Boerhaave's syndrome: a pain in the neck.

Boerhaave's syndrome, or post-emetic rupture of the oesophagus, classically presents with vomiting, chest pain and subcutaneous emphysema. Mortality in this condition is very high and increases dramatically with delayed diagnosis and intervention. The vast majority of patients have a tear in the left posterior-lateral wall of the lower third of the oesophagus and require urgent surgical intervention. Spontaneous rupture of the cervical oesophagus is very rare and may present differently to oesophageal perforations elsewhere. A case is presented following vomiting in a 70-year-old woman, which was diagnosed by computed tomography scan and treated conservatively. The attending physician must be alert to the diagnosis of post-emetic cervical oesophageal perforation as prompt diagnosis and treatment is essential to reduce morbidity and mortality.