{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:53:53Z","timestamp":1777672433471,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Boerhaave\u2019s syndrome is a rare and life-threatening form of spontaneous esophageal perforation, typically triggered by forceful vomiting and often misdiagnosed due to nonspecific clinical features. Although Mackler\u2019s triad (vomiting, chest pain, and subcutaneous emphysema) is classically associated with the condition, it is infrequently observed in full. We present the case of a 32-year-old man with a history of ulcerative colitis (UC) who presented to the emergency department with acute chest pain and repeated vomiting following dinner. He reported a sensation of food impaction and sought care 2\u2009hours after symptom onset. Examination revealed subcutaneous emphysema and abdominal tenderness. Imaging with oral contrast-enhanced computed tomography revealed pneumomediastinum, pneumoperitoneum, and a distal esophageal perforation, confirming Boerhaave\u2019s syndrome. He underwent robotic-assisted laparoscopic repair with anterior fundoplication, endoscopic stenting, and drainage. His postoperative course included thoracentesis, IV antibiotics, and a gradual reintroduction of diet. A mild UC flare was managed with mesalamine. He was discharged in stable condition on postoperative day 9 and had full radiologic recovery at 3\u2009months. This case stands out for its complete presentation of Mackler\u2019s triad, a rare occurrence that facilitated early diagnosis. The patient\u2019s young age and concurrent UC added clinical complexity. Prompt imaging and early minimally invasive surgical management, combined with coordinated multidisciplinary care, were key to a favorable outcome. This case underscores the importance of considering Boerhaave\u2019s syndrome in atypical presentations and acting swiftly when classical signs do appear.<\/jats:p>","DOI":"10.1177\/23247096261416258","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:08:35Z","timestamp":1769162915000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["When Textbook Meets Reality: A Rare Case of Boerhaave\u2019s Syndrome With Mackler\u2019s Triad"],"prefix":"10.1177","volume":"14","author":[{"given":"Taiwo","family":"Ajani","sequence":"first","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2241-3673","authenticated-orcid":false,"given":"Jose","family":"Loayza Pintado","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nayiri","family":"Derian","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Suarez","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernesto","family":"Garza","sequence":"additional","affiliation":[{"name":"Rio Grande Regional Hospital, McAllen, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1250347"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.08.037"},{"issue":"8","key":"e_1_3_2_4_2","article-title":"Atypical presentation of Boerhaave syndrome with hypoxia and unresponsiveness","volume":"14","author":"Bury J","year":"2022","unstructured":"Bury J, Fratczak A, Nielson JA. Atypical presentation of Boerhaave syndrome with hypoxia and unresponsiveness. Cureus. 2022;14(8):e27848.","journal-title":"Cureus"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.16501"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14151592"},{"key":"e_1_3_2_7_2","first-page":"26","article-title":"S\u00edndrome de Boerhaave: reporte de un caso y revisi\u00f3n de la literatura","volume":"89","author":"Salvador-Ibarra IJ","year":"2021","unstructured":"Salvador-Ibarra IJ, Piza\u00f1a-Davila A. S\u00edndrome de Boerhaave: reporte de un caso y revisi\u00f3n de la literatura. Cir Cir. 2021;89(S2):26-30.","journal-title":"Cir Cir"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(89)90119-7"},{"issue":"2","key":"e_1_3_2_9_2","article-title":"Aetiology, clinical manifestations, diagnosis, and treatment of oesophageal perforation: a review","volume":"16","author":"Shaheem S","year":"2024","unstructured":"Shaheem S, Panikkaveettil H. Aetiology, clinical manifestations, diagnosis, and treatment of oesophageal perforation: a review. Cureus. 2024;16(2):e55041.","journal-title":"Cureus"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.12.017"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-019-0245-2"},{"issue":"5","key":"e_1_3_2_12_2","article-title":"Boerhaave syndrome: a report of two cases and literature review","volume":"14","author":"Fawwaz B","year":"2022","unstructured":"Fawwaz B, Gerges P, Singh G, et al. Boerhaave syndrome: a report of two cases and literature review. 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