Postoperative vomiting causing esophageal rupture after antiemetic use. A case report.

BACKGROUND

Antiemetic medications are commonly used in the postoperative patient. Despite the lack of evidence-based data, these medications have also been increasingly used in the management of postoperative ileus. This practice is dangerous and increases the risk for morbidity and mortality.

METHODS

A 77-year-old woman underwent an uneventful total abdominal hysterectomy and bilateral salpingo-oophorectomy. The patient developed abdominal distention and vomiting, which were managed with antiemetic medication. The patient continued to vomit, developed esophageal rupture (Boerhaave's syndrome) and died of sepsis and multiorgan failure.

CONCLUSIONS

Despite no scientific evidence for it, the practice of using antiemetic medications and prokinetic agents in the management of postoperative ileus continues. This places the patient at increased risk for completely preventable morbidity, including aspiration, pneumonia, esophageal perforation, prolonged hospital stay and death.