Searching for the Source of the Leak: PIE and the Macklin Effect

The patient was given analgesics, broad-spectrum antibiotics, a proton pump inhibitor, and was transferred to a tertiary referral center for subspecialty management of her condition. If Boerhaave syndrome or laryngotracheal injury remain diagnostic considerations on clinical grounds (such as when findings of sepsis are present or a recent tracheal procedure was performed), a contrasted swallow study and/ or endoscopic evaluation may still be necessary but is not routinely performed. (Received in original form March 22, 2018; accepted in final form August 21, 2018) Supported by National Institutes of Health/National Heart, Lung, and Blood Institute grant T32HL105346-07 (D.W.R.).