Anatomy of the Boerhaave syndrome.

BACKGROUND: Spontaneous rupture of the esophagus (Boerhaave syndrome) occurs almost invariably at the same anatomic site. A weakness of the distal esophageal wall is suspected but has not been confirmed by anatomic studies. The aim of this work was to determine the existence of a structural abnormality in the esophageal wall.

MATERIAL AND METHODS: In six fresh human cadavers, the left lung was removed and the esophagus was insufflated in situ with air until it burst. The mucosa of the specimens was stripped off, allowing the fibers of the inner muscular coat to be seen. In addition a specimen from a patient who died from this cause was submitted to the same procedure.

RESULTS: The site of the experimental rupture matched the clinical case. The tear was located at the margin of contact between "clasp" and oblique fibers, and extends upwards.

CONCLUSIONS: The connective tissue of the junction between clasp and oblique fibers appears to constitute a weak point in the lower esophagus.