To the Editor.—
I refer to the Letter to the Editor by Gallivan1 commenting on our article entitled "Postemetic Rupture of Herniated Cardia of the Stomach."2 Although this is a somewhat delayed response to that letter, I believe that there still may be something new above the diaphragm after all.Our case represents a classic postemetic or spontaneous rupture similar to that reported by Boerhaave3 in 1724 with the exception that the anatomic site of rupture occurred in a herniated cardia of the stomach rather than in the lower esophagus. In postemetic rupture, the cause remains unclear, but it is postulated that the extension of smooth-muscle fibers from the esophagus onto the stomach wall results in a defective or weakened muscular zone. As we mentioned in our article, the perforation is almost always in the lower third of the esophagus, and about 90% occur on the left
James EC. Postemetic Rupture of Herniated Cardia of the Stomach. JAMA. 1984;251(4):471. doi:10.1001/jama.1984.03340280027019
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