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J Emerg Med. 2016 Dec;51(6):e141-e143. doi: 10.1016/j.jemermed.2016.05.061. Epub 2016 Sep 29.

Esophageal Rupture After Ghost Pepper Ingestion.

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Department of Emergency Medicine, University of California - San Francisco, San Francisco, California.
Department of Emergency Medicine, Alameda County Medical Center/Highland Hospital, Oakland, California.
School of Pharmacy, University of California - San Francisco, San Francisco, California.



The ghost pepper, or "bhut jolokia," is one of the hottest chili peppers in the world. Ghost peppers have a measured "heat" of > 1,000,000 Scoville heat units (SHU), more than twice the strength of a habanero pepper. To our knowledge, no significant adverse effects of ghost pepper ingestion have been reported.


A 47-year-old man presented to the Emergency Department (ED) with severe abdominal and chest pain subsequent to violent retching and vomiting after eating ghost peppers as part of a contest. A subsequent chest x-ray study showed evidence of a left-sided pleural effusion and patchy infiltrates. A computed tomography scan of the abdomen and pelvis showed pneumomediastinum with air around the distal esophagus, suggestive of a spontaneous esophageal perforation and a left-sided pneumothorax. The patient was intubated and taken immediately to the operating room, where he was noted to have a 2.5-cm tear in the distal esophagus, with a mediastinal fluid collection including food debris, as well as a left-sided pneumothorax. The patient was extubated on hospital day 14, and was discharged home with a gastric tube in place on hospital day 23. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous esophageal rupture, Boerhaave syndrome, is a rare condition encountered by emergency physicians, with a high mortality rate. This case serves as an important reminder of a potentially life- threatening surgical emergency initially interpreted as discomfort after a large spicy meal.


Boerhaave syndrome; bhut jolokia; esophageal rupture; ghost pepper; pneumomediastinum

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