Differences

I recently was involved with a case of Boerhaave syndrome. This was only the second one I have seen, and I was struck by the difference in the way this patient was managed here, in a first world setting, compared to back home in South Africa.

Here, he came in to the A&E with chest pain after vomiting, after a night out on the town. He was was scanned, resuscitated, intubated, bilateral chest drains inserted, and referred for thoracotomy and repair, all within a few hours.

Here are a few of his pictures (sorry about the poor quality). You can clearly see the pneumomediastinum (air where it shouldn't be in the chest), partucularly circling the oesophagus, and bilateral pleural effusions (fluid where it shouldn't be in the chest - in this case stomach content).

 

Back home, she came in with a practically "spontaneous" oesophagus perforation secondary to severe oesophageal candidiasis (thrush) causing ulceration, with underlying stage IV AIDS. She was admitted to the ward on a morphine infusion to await the inevitable.