Question

A patient after a heavy meal comes with epigastric pain. On examination tenderness and rigidity in the upper abdomen. X-ray showing pneumomediastinum. What can be the cause

• A. Spontaneous esophageal rupture
• B. Penetrating foreign body injury to esophagus
• C. Perforated peptic ulcer
• D. Rupture of emphysematous bulla

Answer 1

The Correct Option is A

In this scenario, we are presented with a clinical case where a patient experiences epigastric pain after a substantial meal, accompanied by tenderness and rigidity in the upper abdomen. A critical finding from the X-ray is pneumomediastinum, which is free air in the mediastinum.

Now, let's analyze each option:

1. Spontaneous esophageal rupture: This condition, also known as Boerhaave syndrome, typically occurs after forceful vomiting, leading to a tear in the esophageal wall. The tear allows air to escape into the mediastinum, resulting in pneumomediastinum. It aligns well with the patient's presentation after a large meal, as overeating can provoke vomiting.
2. Penetrating foreign body injury to esophagus: While a foreign body can cause esophageal injury, it's less likely to cause the acute situation described without additional details of ingestion of a foreign object.
3. Perforated peptic ulcer: This usually results in air under the diaphragm visible on an X-ray, known as pneumoperitoneum, rather than pneumomediastinum. The patient's presentation is less typical for peptic ulcer perforation.
4. Rupture of emphysematous bulla: This occurs in patients with chronic lung disease and would typically be associated with pneumothorax rather than pneumomediastinum. There is no mention of lung disease in this case.

Given the symptoms of postprandial pain, tenderness, rigidity, and the presence of pneumomediastinum, the most consistent cause is spontaneous esophageal rupture, which fits this clinical presentation optimally.