Cervicomediastinal abscess due to occult esophageal perforation with spontaneous sealing: a case report of an unusual presentation of boerhaave syndrome

Boerhaave syndrome is a rare but potentially fatal condition resulting from spontaneous esophageal perforation, typically associated with a characteristic clinical triad of vomiting, chest pain, and subcutaneous emphysema. However, in some cases, symptoms may be nonspecific, and initial diagnostic studies inconclusive, which can lead to delayed recognition and treatment. We report a case of a healthy young adult who developed cervical pain, odynophagia, and systemic symptoms after multiple episodes of vomiting. Despite normal findings on endoscopy, further imaging studies were conducted due to ongoing clinical suspicion, which revealed a cervicomediastinal abscess that required surgical drainage. This case highlights the importance of maintaining a high index of suspicion for Boerhaave syndrome and the need for advanced imaging in patients with suggestive symptoms, even when initial evaluations appear normal. It is important to emphasize that some cases of rupture may resolve spontaneously, which can complicate the diagnostic process. Timely diagnosis and intervention are key to improving outcomes in this condition.