Pediatr Emerg Med J.  2023 Jan;10(1):36-40. 10.22470/pemj.2022.00591.

A case of esophageal perforation caused by suicidal caffeine poisoning in a teenager

• Kim SJ
• Choi Yj
• Lee KS
• Jang HJ
• Moon JH
• Kim YJ
• Yang S

• KMID: 2538081
• DOI: http://doi.org/10.22470/pemj.2022.00591

Abstract

Spontaneous esophageal perforation (also known as Boerhaave syndrome) is associated with sudden increase in intra-esophageal pressure by vomiting, coughing or straining at stool. This case describes a 13-year-old girl who developed the perforation after consuming 270 mg/kg of caffeine tablets for a suicide attempt. Presumably, the perforation was caused primarily by caffeine-induced severe vomiting, and secondarily by caffeine-induced gastric acid secretion with smooth muscle relaxation and by the large amount of caffeine-induced sudden increase in intra-esophageal pressure.

Keyword

Adolescent; Caffeine; Drug-Related Side Effects and Adverse Reactions; Esophageal Perforation; Poisoning; Spontaneous Perforation; Suicide, Attempted

Figure

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  Fig. 1. Initial plain radiograph showing the subcutaneous emphysema (white arrow) in both sides of the lower neck and axillae, and pneumomediastinum (black arrow).

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  Fig. 2. Computed tomography scan of the chest showing the esophageal rupture, subcutaneous emphysema, and pneumomediastinum (day 1). It shows the scanty pneumothorax (white arrow, A), subcutaneous emphysema in the lower neck, axillae, and chest wall (black arrow, A), interstitial emphysema (arrowhead, A) in both lungs, and extensive pneumomediastinum (arrow, B). Of note, diffuse esophageal wall thickening with suspicious slit-like wall defect (arrow, C) indicates the esophageal rupture.

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  Fig. 3. Upper gastrointestinal endoscopic findings (day 2). Deep longitudinal tears (arrows, A) and ulcers (arrowhead, A) with severe bleeding are noted in the distal esophagus. The cardia shows active superficial ulcers (arrow, B) with current bleeding (arrow, C). Many ulcers are also noted in the first (image of the first portion is not shown) and the second portions of the duodenum. The ulcers are in a circumferential form, and are covered with creamy exudates (arrow, D).

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  Fig. 4. Follow-up endoscopic findings (day 13). The previous bleeding and ulcers in the distal esophagus are improved with minor focal bleeding and good luminal patency (A). The previous gastric ulcers and hemorrhage are also improved with minor hemorrhagic spots noted in the cardia (B and C). The duodenal circumferential ulcers are in healing status (D).

Reference

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