232 Case Report: A Case of Recurrent Boerhaave’s Syndrome

Abstract Introduction Boerhaave’s syndrome is a rare but potentially life-threatening rupture of the oesophagus. Despite advances in diagnosis and management, it still has a high mortality rate. While single episodes of Boerhaave’s syndrome are uncommon, recurrent spontaneous oesophageal perforations are exceedingly rare. Case Presentation This is a case of a 45-year-old gentleman, presenting with Boerhaave’s syndrome 3 times, over 26 months. He initially presented in April 2023 and was managed with a thoracotomy and primary repair of the oesophagus over a T-tube which failed. An attempt at disconnection was undertaken but abandoned due to a hostile chest and the patient was subsequently managed with endovac therapy. Second presentation was October 2024. He was initially managed with endovac therapy but due to the chronic chest cavity poor progress was made. A covered oesophageal stent was utilised alongside chest drainage. In April 2025, he was re-admitted with a further episode. Again, he was managed with endovac therapy and Vac Stent placement. His most recent admission has been complicated by poor functional status, ongoing respiratory issues and he has been discharged to his base hospital for prolonged tracheostomy weaning. Discussion Recurrent Boerhaave’s syndrome challenges the traditional assumption that a successfully treated oesophageal rupture is a one-time event. While the management in the repeated episodes does not necessarily differ substantially, what becomes more nuanced is the decision-making surrounding treatment. Particularly in this case, where each time the patient is in a much poorer physiological state, making the decision making even more complex.