Lack of muscularis mucosa and the occurrence of Boerhaave's syndrome

Six patients with spontaneous rupture of the esophagus (Boerhaave's syndrome) were surgically treated in the Department of Surgery II, Kyushu University. Two patients underwent esophageal resection. Histopathologic examinations revealed the absence of muscularis mucosa around the sites of esophageal rupture in these two patients. In the patient treated most recently, serial histologic investigation demonstrated that the lack of muscularis mucosa existed not only around but also along the longitudinal extension of the site of rupture. This finding suggests that lack of muscularis mucosa in the esophageal wall may be one cause of spontaneous rupture of the esophagus.