Boerhaave's Syndrome Post-colonoscopy: When Emesis Conceals an Emergency

Boerhaave syndrome, a rare yet life-threatening spontaneous esophageal rupture, is classically associated with forceful emesis. We present a case of a 48-year-old male with no prior esophageal pathology who developed vomiting, epigastric pain and dyspnea after undergoing an elective colonoscopy. Notably, the patient had experienced emesis following alcohol consumption the day prior to the colonoscopy procedure but did not disclose this history during the pre-procedural assessment. Initial assessments misattributed his symptoms to sedation-related nausea and post-procedural ileus, thereby delaying critical diagnostic imaging. The computed tomography (CT) combined with esophagography revealed pneumomediastinum and a 1.5 cm distal esophageal tear. Surgical pleural decortication was performed. The patient recovered after four weeks of multidisciplinary care.