A 37-year-old runner was competing in his first 160-kilometer (100-mile) race when he began experiencing severe pain in the lower left side of his chest and the upper right area of his abdomen. Moments before, he had taken an over-the-counter anti-inflammatory pill and immediately vomited, spitting up the pill in the process.
The pain was so severe that he thought he had broken a rib.
“After I vomited, I felt an intense pain in my abdominal area and breathing was very difficult. I thought perhaps I was ‘winded’ temporarily, but my breathing did not improve,” said the runner, according to a BMJ case report.
Lying down made the pain along his left side “significantly worse," but his vital signs remained normal. Responders immediately transported him to an emergency room.
“When I was in the first ambulance, the paramedic treated me as if I was having a heart attack. I did not realize the seriousness of my situation until I saw the look of concern in the radiologist’s eyes after the contrast X-ray revealed the rupture,” he added.
Typically, runners who experience chest pain are treated for cardiac causes, but the man was otherwise healthy. Researchers found that he had experienced an esophageal rupture, a rare and often lethal disorder otherwise known as Boerhaave’s syndrome due to “forceful emesis,” or vomiting. The left side of his esophagus had torn.
“While up to 96 percent of ultrarunners will have some gastrointestinal distress during a race, we have not seen this complication described in the literature,” wrote the treating physicians, adding that the syndrome is fatal in up to 20 percent of those diagnosed with it. About three cases per million people occur each year, according to a study based in Iceland. The condition occurs more frequently in older men who overindulge in alcohol and food.
The patient underwent a bronchoscopy, a procedure where surgeons pass a thin tube (bronchoscope) through the nose or mouth and down into the throat. In all, the runner spent a total of 41 days in three hospitals and more than a month being fed through a tube.
“I had to learn to breathe again, walk again, and after 70 days I was able to start running again. The whole experience gave me a new perspective on life and the importance of health, and I have learned to appreciate the little things in life,” said the patient.
The report authors say that this case suggests that medical professionals need to consider a variety of causes for athletes who experience pain, especially those who are at low risk of cardiac events.