Spontaneous pneumomediastinum in an 18-year-old woman: the importance of excluding oesophageal perforation.

An 18-year-old woman presented to the emergency department with a 3-day history of vomiting, central abdominal pain and decreased oral intake. She described frequent episodes of bilious vomit without haematemesis. She denied previous alcohol or illicit drug use, smoking or recent travel. There was