(Re)building the Wall: Recurrent Boerhaave Syndrome Managed by Over-the-Scope Clip and Covered Metallic Stent Placement

A 62-year-old man was initially evaluated at a local hospital complaining of shortness of breath and severe, persistent pain in the chest and epigastric regions with radiation to the left shoulder and neck. The pain was exacerbated by hiccupping, coughing and deep inspiration. He reported heavy alcohol consumption and recurrent migraine headaches the night before and that the pain had followed a protracted episode of retching and vomiting. His past medical history was notable for a 4-cm ascending aortic aneurysm and two previous episodes of esophageal rupture occurring under similar circumstances. The first episode of perforation had occurred 12 years previously and was managed with chest tube placement and antibiotics. The second, which had occurred 4 years previously, had resulted in a tracheo-esophageal fistula that was managed by endoscopic stent placement and right-sided empyema requiring thoracotomy with decortication and debridement. The...