Endoscopic Treatment of Boerhaave Syndrome Related Empyema

Empyema and Boerhaave syndrome are both life-threatening conditions. We present a patient who suffered from Boerhaave syndrome complicated by left empyema, who had sepsis controlled with adequate pleural drainage and timely endoscopic oesophageal repair. A preceding history of vomiting with the occurrence of polymicrobial empyema with <i>Candida</i> involvement should prompt the suspicion of Boerhaave syndrome, despite the absence of classical Mackler's Triad. Early recognition of these interlinked conditions is essential for facilitating prompt management. Intravenous and oral contrast-enhanced computed tomography is crucial in evaluating the thoracic space and identifying an oesophageal leak. Intravenous antibiotics and repair of the oesophageal perforation can help to control sepsis and improve clinical outcome. Endoscopic repair is a viable alternative to surgical repair in select patients and can be considered even in those with a delayed presentation.