Boerhaave Syndrome Caused by Pancreatitis-Induced Gastric Outlet Obstruction: A Case Report.

Boerhaave syndrome is a spontaneous transmural perforation of the esophagus, typically triggered by forceful vomiting and carrying a high mortality rate when diagnosis is delayed. We present a 56-year-old man with chronic alcohol use disorder who developed esophageal perforation through an unusual causal chain. He presented with intractable vomiting, hematemesis, and cervical subcutaneous emphysema. Computed tomography showed posterior pneumomediastinum and marked gastric and duodenal distention caused by an inflammatory cephalopancreatic mass. Elevated pancreatic enzymes confirmed acute pancreatitis. The sequence appeared to be alcoholic pancreatitis compressing the duodenum, causing gastric outlet obstruction, protracted emesis, and esophageal rupture. On the day of admission, laparoscopic primary two-layer esophagorrhaphy and gastrojejunostomy were performed to address both the perforation and the duodenal obstruction. The postoperative course was complicated by recurrent pancreatitis and bilateral pleural effusions, but serial imaging confirmed no leak at the esophageal repair or the anastomosis. The patient was discharged on postoperative day 25. Follow-up magnetic resonance cholangiopancreatography excluded pancreatic malignancy and showed findings consistent with groove pancreatitis and chronic pancreatitis. This case illustrates an unusual causal chain in which acute pancreatitis led to esophageal perforation via gastric outlet obstruction and reinforces the benefit of same-day surgical repair when both the perforation and its cause can be addressed in a single procedure.