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November 17, 1978

Boerhaave's Prescience

Author Affiliations

University of California, Los Angeles School of Medicine Los Angeles

JAMA. 1978;240(21):2249. doi:10.1001/jama.1978.03290210031016

To the Editor.—  The recent CLINICAL NOTE by Brown and Cohen (240:140, 1978) is the latest of several recent case reports wherein nutritional support by means of total parenteral nutrition permitted successful nonoperative management of spontaneous postemetic rupture of the esophagus, the so-called Boerhaave's syndrome.Treatment of this disease is associated with considerable postoperative morbidity and even mortality despite the most favorable of circumstances such as early diagnosis, prompt operative intervention, and minimal tissue contamination and necrosis. It is therefore likely that total parenteral nutrition will be used more frequently in such cases and may in fact facilitate the conservative treatment of those carefully selected patients in whom the diagnosis is not made until late in the course of the disease and whose clinical condition is stable.Hermann Boerhaave, professor of the theory and practice of physic at the University of Leyden and the leading physician of his time, anticipated