PMC4756090_01
Preoperative endoscopic findings.. Upper gastrointestinal endoscopy revealed the site of perforation in the left wall of the distal esophagus (upper) and a twisted gastric body toward the head resulting in outlet obstruction (lower).
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This revealed a deep ulcerated lesion on the left side of the distal esophagus and the endoscope could not pass through to the distal stomach because the stomach was twisted toward the proximal portion (Fig. 1).
Preoperative Computed Tomography scan findings.. A computed tomography scan showed frank pneumomediastinum and a left pleural effusion. Coronal view of the computed tomography scan showed an upside down stomach with mesenterico-axial volvulus. Du: duodenum.
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In addition, coronal views on the CT scan revealed an upside down appearance of the stomach with a mesentero-axial volvulus (Fig. 2).
Preoperative gastrografin swallow.. A preoperative gastrografin swallow showed extravasation of contrast in the left chest.
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A gastrografin swallow showed extravasation of contrast in the left chest, confirming the diagnosis of Boerhaave's syndrome (Fig. 3).