Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with sudden onset of severe, sharp retrosternal chest pain following forceful emesis/retching (Mackler triad). Associated with diaphoresis, dyspnea, and signs of systemic inflammatory response. No history of prior esophageal instrumentation.
Clinical Examination Findings
Vitals reveal tachycardia, tachypnea, and hypotension. Physical exam demonstrates subcutaneous emphysema in the suprasternal notch (Hamman sign). Abdominal exam shows rigidity and rebound tenderness suggestive of chemical mediastinitis or peritonitis.
Treatment Protocol
Immediate NPO status, aggressive fluid resuscitation, and broad-spectrum IV antibiotics. Emergent surgical consultation for thoracotomy/laparotomy with primary esophageal repair, drainage of the mediastinum, and placement of feeding jejunostomy tube.