Author: Ahmed Sakr, Mahnoor Tayyib / Editor: Stephen Sheridan / Codes: CP2, GP10, SLO1, SLO3 / Published: 19/03/2026
A 50-year-old man presents to the Emergency Department (ED) with sudden onset of severe central chest pain radiating to the left side, following multiple episodes of forceful vomiting after eating pork meat. He reports shortness of breath and a sensation of something stuck in his chest. Vomiting hasn’t stopped after anti-emetic medication.
On examination, he is vitally stable: blood pressure is 159/76 mmHg, heart rate is 95 beats per minute, respiratory rate is 22 breaths per minute, and SPO2 97%. His chest is clear with no wheezes or crepitations, but there was palpable crepitus of the chest wall. A soft tissue neck and chest x-ray confirm the clinical findings of surgical emphysema in the anterior chest wall. A CT chest with contrast confirms the diagnosis, of oesophageal rupture with extraluminal air and food residue.
He receives intravenous fluids, antibiotics, and an urgent surgical referral.
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