Spontaneous Rupture of the Esophagus (Boerhaave Syndrome)

JAMA ◽  
1976 ◽  
Vol 235 (5) ◽  
pp. 526 ◽  
Author(s):  
T. Curtis Campbell
Keyword(s):  
Spontaneous Rupture ◽  
Boerhaave Syndrome

P166 SPONTANEOUS ESOPHAGEAL RUPTURE – BOERHAAVE SYNDROME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B  Movchan ◽  
O Usenko ◽  
A Zgonnyk ◽  
R Vynogradov
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Clinical Manifestations ◽  
Esophageal Rupture ◽  
Esophageal Stents ◽  
Spontaneous Esophageal Rupture ◽  
Timely Diagnosis ◽  
Boerhaave Syndrome ◽  
Surgical Tactics ◽  
Effective Drainage

Abstract Aim To study the most effective method of treatment in patients with spontaneous rupture of the esophagus. Background The timely diagnosis of Boerhaave syndrome presents great difficulties due to its rarity, a variety of clinical manifestations, often simulating different pathologies from other organs and are difficult to treat. Methods From 2003 to 2019 9 patients with Bourhave's syndrome were treated at the clinic, primary care was provided to 6 patients in the community. All patients were admitted to the clinic with external left-sided esophageal-pleural fistula, 1 patient had a spontaneous rupture of the esophagus in the cliniс, the defect of the esophagus wall defect was completed, which led to successful results. Results Treatment in the remaining patients was started with adequate enteral nutrition and effective drainage of the pleural cavity. As a result of the use of pleural double-lumen drainage with active sanation with antiseptics and subsequent aspiration, with the exception of feeding through the mouth in four patients, it was possible to eliminate the esophageal-pleural fistula, profuse bleeding and death of the patient. Against the background of ongoing conservative therapy in two patients, it was not possible to eliminate the esophago-pleural fistula. A left-sided thoracotomy was performed with excision of the fistula with the decortication of the lung and the extirpation of the esophagus with the formation of an esophagostomy. Subsequently, these patients underwent retrosternal colic esophagoplasty. Two patients underwent Lewis surgery with drainage of the pleural cavity. Conclusion Boerhaave syndrome has a very high mortality rate, however, with a timely diagnosis and adequate surgical tactics, it develops into the formation of an esophageal-pleural fistula. In this case, the most effective treatment is excision of the fistulous course with extirpation of the esophagus and subsequent esophagoplasty. The use of esophageal stents is possible in extremely depleted patients or in elderly patients, due to the frequent occurrence of hypergranular esophagitis. Esophageal stents should be removed as soon as possible when confidence in the elimination of the esophageal-pleural fistula occurs.

scholarly journals FIRST EXPERIENCE OF USING ENDOSCOPIC VACUUM-ASSISTED AND ASPIRATION THERAPY IN THE TREATMENT OF SPONTANEOUS RUPTURE OF THE ESOPHAGUS (BOERHAAVE SYNDROME)

2017 ◽  
Vol 2 (1) ◽  
pp. 136-140
Author(s):  
Вячеслав Ринчинов ◽  
Vyacheslav Rinchinov ◽  
Александр Плеханов ◽  
Alexander Plekhanov ◽  
Баир Цыбикдоржиев ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
Boerhaave Syndrome

scholarly journals Results of treatment for Boerhaave syndrome

2019 ◽  
Vol 27 (1) ◽  
pp. 66-74
Author(s):  
Aleksey V. Mikheev ◽  
Sergey N. Trushin
Keyword(s):  
Primary Care ◽  
Surgical Treatment ◽  
Spontaneous Rupture ◽  
Surgical Intervention ◽  
Esophageal Rupture ◽  
Results Of Treatment ◽  
Boerhaave Syndrome ◽  
The Moment ◽  
Suture Failure

Background. Spontaneous rupture of the esophagus (Boehaave syndrome, BS) is a rare pathology in the surgical practice. Esophageal rupture makes no more than 2-3% of all cases of damage to the esophagus and is associated with a significant number of diagnostic errors and with high mortality. Aim. The aim of the study was to analyze the quality of diagnostics and the results of treatment of patients with spontaneous rupture of the esophagus. Materials and Methods. We performed a retrospective analysis of medical histories and of treatment results of 10 patients with Boerhaave syndrome hospitalized in the department of thoracic surgery of the Ryazan Regional Clinical Hospital, Ryazan in 2007-2018. Results. Four of ten patients were transferred from other medical institutions. At the primary care stage six patients were misdiagnosed; two of them underwent diagnostic laparoscopy for suspicion of acute pancreatitis and perforated gastric ulcer. The average time from the onset of the disease to surgery was 71.723.4 hours. Closure of the esophageal perforation was performed in all cases. Regarding the timing of surgery, all patients with Boerhaave syndrome were divided into 2 groups: patients with early intervention (4 patients operated within 24 hours); patients with late intervention (5 patients operated after 48 hours from the onset of the disease). One patient underwent surgical treatment within 24 hours in a medical facility outside the Ryazan region. In nine out of ten patients the rupture was localized in a typical place in the lower third of the esophagus along the left lateral wall. In the postoperative period eight patients had complete or partial esophageal suture failure, which required prolonged inpatient treatment (54.712.1 days). Postoperative mortality was 10% (1 patient of 10) and was caused by the progressive multi-organ failure and the development of cerebral ischemic stroke. Conclusion. The quality of diagnostics of Boerhaave syndrome remains unsatisfactory: due to rare occurrence of this pathology, most specialists of primary care settings, including surgeons, are not well acquainted with the etiopathogenesis and peculiarities of clinical presentation of Boerhaave syndrome. Diagnostic and treatment errors in rendering primary medical assistance reaches 60%. Results of surgical treatment directly correlate with the time from the moment of perforation and development of septic complications. Even with early surgical intervention performed within 24 hours from the moment of perforation, esophageal suture failure may occur in up to 75% of cases. Thus, the success of treatment is determined by early diagnosis, timely hospitalization in a specialized facility, and adequate surgical intervention.

scholarly journals THE CHOICE OF SURGICAL TACTICS FOR BOERHAAVE SYNDROME IN COMBINATION WITH BILATERAL PLEURAL EMPYEMA (CLINICAL CASE)

2021 ◽  
pp. 39-46
Author(s):  
V. A. Gankov ◽  
D. Yu. Shestakov ◽  
V. V. Manshetov ◽  
E. A. Tseimakh ◽  
E. V. Kovalev ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Pleural Empyema ◽  
Posterior Mediastinum ◽  
Complete Healing ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Surgical Access ◽  
Left Pleural Cavity ◽  
Boerhaave Syndrome

Introduction. Boerhaave syndrome is a rare, difficult to diagnose and formidable disease with a high mortality rate. For the treatment of this pathology, many variants of interventions have been proposed. Some surgeons prefer to use a thoracotomic access, others – a laparotomic transhiatal one. In the domestic literature there are scant observations of usement of minimally invasive technologies.Clinical observation. The patient was admitted to the surgical department for emergency indications. In the admission department spontaneous left side hydropneumothorax was diagnosted. Drainage of the left pleural cavity was performed. On the second day, a spontaneous rupture of the esophagus was diagnosed. Video-laparotranschiatal drainage of the posterior mediastinum, drainage of the left subhepatic space, Maydl jejunostomy was performed. In the postoperative period, intensive conservative therapy was carried out, massive lavage of the mediastinum and the left pleural cavity with antiseptic solutions. For a long time, there was a large drainage debit. Because of treatment the dynamics were positive. On the 45th day the drainage of the pleural cavity was removed. By the 66th day complete healing of the esophageal defect and removal of the mediastinal drainage.Discussion. Due to the difficulties in diagnosis, a spontaneous rupture of the esophagus was detected a day later. The applied surgical access and technique allowed to provide adequate drainage and sanitation of the posterior mediastinum and left pleural cavity. The subsequent tactics of managing the patient ensured his recovery. The trauma of the video-laparotranschiatal access is less, in comparison with open surgical interventions. We consider the experience of using video endoscopic technologies for Boerhaave syndrome positive and promising.

scholarly journals INNOVATIVE DIAGNOSTIC METHODS FOR THE TREATMENT OF PATIENTS WITH BOERHAAVE SYNDROME AND ITS COMPLICATIONS

2021 ◽  
Vol 21 (4) ◽  
pp. 48-53
Author(s):  
К. G. Kubachev ◽  
В. A. Apereche ◽  
S M. Babaev
Keyword(s):  
Spontaneous Rupture ◽  
Diagnostic Methods ◽  
Vacuum Therapy ◽  
Esophageal Rupture ◽  
Treatment Results ◽  
Improve Treatment ◽  
Boerhaave Syndrome ◽  
Esophageal Stenting

Transluminal endoscopic interventions in the treatment of patients with spontaneous rupture of the esophagus can significantly improve treatment results. Esophageal stenting and vacuum therapy for the treatment of esophageal rupture and suture incompetence are alternatives to surgery.

scholarly journals Recurrent, Spontaneous Esophageal Ruptures Associated With Antiphospholipid Antibody Syndrome: Report of a Case

2014 ◽  
Vol 99 (6) ◽  
pp. 842-845 ◽  
Author(s):  
Hiroshi Naitoh ◽  
Minoru Fukuchi ◽  
Shinsuke Kiriyama ◽  
Takaharu Fukasawa ◽  
Yuichi Tabe ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
English Literature ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Esophageal Rupture ◽  
Vascular Thrombosis ◽  
Spontaneous Esophageal Rupture ◽  
Increased Risk ◽  
Boerhaave Syndrome ◽  
Syndrome Report

Abstract A 52-year-old man was admitted to our hospital with a spontaneous esophageal rupture (Boerhaave syndrome) and was successfully treated. Eight years after the first incident, he was readmitted with a recurrent rupture. Recurrence of Boerhaave syndrome is extremely rare, with only 7 cases reported in the English literature. During treatment, the patient was also diagnosed with antiphospholipid syndrome (APS). Although APS is known to cause a variety of symptoms due to vascular thrombosis, recurrence of Boerhaave syndrome, coincident with APS, has never been reported. The pathogenesis of Boerhaave syndrome has not been clearly determined. This report serves to increase awareness of the risk of APS, which results in an increased risk of spontaneous rupture of the esophagus.

Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome

2013 ◽  
Vol 79 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Michael Schweigert ◽  
Rory Beattie ◽  
Norbert Solymosi ◽  
Karen Booth ◽  
Attila Dubecz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Spontaneous Rupture ◽  
Fatal Outcome ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Stent Group ◽  
Endoscopic Stent ◽  
Boerhaave Syndrome

Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy.

scholarly journals Laparoscopic surgery by spontaneous rupture of the esophagus, a case report of treatment Boerhaave syndrome

2020 ◽  
Vol 7 (10) ◽  
pp. 3442
Author(s):  
Eduard A. Galliamov ◽  
Igor V. Semenyakin ◽  
Sergey A. Erin ◽  
Evgeniy A. Kytirev ◽  
Grigorii Y. Gololobov ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Spontaneous Rupture ◽  
Positive Response ◽  
Response To Treatment ◽  
Esophageal Rupture ◽  
Invasive Approach ◽  
Perforation Hole ◽  
Spontaneous Esophageal Rupture ◽  
Somatic Status ◽  
Boerhaave Syndrome

Spontaneous rupture of the esophagus, Boerhaave syndrome, is a rare pathology and emergency condition for the patient. Patient, 63-year-old, on the 6th day of the disease falls into the clinic, where a Boerhaave syndrome was diagnosed. Laparoscopic surgery was performed. Sanitation and drainage of the mediastinum, suturing of the perforation hole were performed. After the operation, а positive response to treatment was observed. A group of authors believes that a minimally invasive approach to the treatment of spontaneous esophageal rupture is the alternative method for patients with severe somatic status and a small perforated opening of the esophagus.

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