Q: Your nerdy ER doc called you to admit a 54 year old male with Mackler's triad. (Hint) Patient has previous history of alcohol abuse and perforated duodenal ulcer. What is Mackler's triad?


Answer: Mackler's triad includes

• lower chest pain,
• vomiting, and
• subcutaneous emphysema

It is a classic presentation of esophageal rupture (Boerhaave's syndrome) but present only in few patients (14%).

 

To note, the triad has been reported without esophageal perforation too.

 

Tachypnea and abdominal rigidity are usually present along with tachycardia, diaphoresis, fever, and hypotension. Unusual clues include hoarseness caused by involvement of the recurrent laryngeal nerve, tracheal shift, cervical vein distention, and proptosis.

 

Condition can quickly progress to multi-organ failure.