Esophageal rupture and spinal anesthesia.

Spontaneous rupture of the esophagus was first reported in the medical literature in 1724 when, in a 70page monograph entitled ”History of grevius disease not previously described,” Boerhaave described the clinical picture and autopsy findings in Baron von Wassenaer, Grand Admiral of the fleet of Holland. The Baron had been ”gorging himself to the point of discomfort and then, inducing regurgitation so he could return to enjoy more gluttony” (1). After a violent episode of vomiting he complained bitterly of severe chest pain and died 18 h later. At postmortem examination Boerhaave discovered a tear in the distal esophagus, with food particles in the pleural cavity. Lately, physicians are becoming more aware of spontaneous rupture of the esophagus with an increasing number of published reports (2-4). We describe here a case of spontaneous rupture of the esophagus during the course of spinal anesthesia, in which unusual features confused the diagnosis.