# An Injection Leading to Oesophageal Perforation: A Rare Case of Contained Boerhaave’s Syndrome Following Unsupervised GLP-1/GIP Receptor Agonist Dose Escalation

## TL;DR

An 18-year-old woman developed a rare contained oesophageal perforation after self-escalating GLP-1/GIP receptor agonist doses, managed successfully without surgery.

## Contribution

Reports a rare case linking unsupervised GLP-1/GIP therapy to oesophageal injury and conservative management success.

## Key findings

- Self-escalation of GLP-1/GIP agonist led to severe vomiting and contained oesophageal perforation.
- Conservative treatment with IV antibiotics and fluids successfully managed the injury.
- Imaging showed pneumothorax and mediastinal emphysema without contrast extravasation, indicating spontaneous sealing.

## Abstract

Oesophageal perforation, also known as Boerhaave’s syndrome, is a rare but potentially fatal condition that classically results from forceful emesis. Prompt diagnosis is critical, as delays are associated with a significant increase in morbidity and mortality. We present the case of an 18-year-old woman who developed severe and persistent vomiting after self-escalation of a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist prescribed for weight loss, culminating in a contained oesophageal perforation. Imaging demonstrated a pneumothorax and extensive mediastinal emphysema (pneumomediastinum), without evidence of ongoing contrast extravasation on water-soluble swallow, suggesting spontaneous sealing of the perforation. The patient was successfully managed conservatively on a medical ward with intravenous (IV) antibiotics, IV fluids, proton pump inhibitor (PPI) therapy, and close clinical observation.

This case highlights the importance of recognising severe vomiting associated with GLP-1/GIP receptor agonist therapy as a potential precipitant of oesophageal injury and demonstrates that carefully selected contained perforations may be successfully managed conservatively with close multidisciplinary monitoring.