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Boerhaave syndrome is a rare disease with a mortality rate that varies from 10 to 40%. The typical clinical presentation
(vomiting, pain, subcutaneuous emphysema) is relatively infrequent. In the case of atypical clinical presentation CT
scan with contrast medium administered per os is fundamental for diagnosis. Though there is no general consensus on
therapeutic strategies, prognosis is dependent on time interval between onset and diagnosis. We observed four patients
with Boerhaave syndrome with an atypical presentation. The time lapse between acute event and diagnosis was less than
6 hours in two cases, 24 hours in one case and 72 hours in the last. All patients presented abdominal pain at admission,
preceeded by vomiting in two cases. In all cases diagnosis was carried out by CT scan. All patients were treated
surgically: in one case raffia alone was performed, in two cases raffia was associated with temporal bipolar oesophageal
exclusion, one case went through oesophageal resection with delayed reconstruction of digestive continuity. One patient
with severe COBP died from post-surgical sepsis. One fistula after cervical recanalisation and another after raffia of the
oesophageal lesion were successfully treated with endoscopy. We suggest that an aggressive surgical approach is the best
treatment for this rare and often severe disease.