EP.WE.1015Management of Boerhaave Syndrome

Abstract Aim Boerhaave’s Syndrome is a rare and fatal condition, characterised by a distal oesophageal tear induced by an abrupt rise in intra-luminal pressure. Treatment remains controversial; we present a recent case and review relevant literature. Methods A retrospective analysis of case-notes was performed, and a literature review undertaken on PubMed. Results A 58-year-old male presented as an emergency with severe chest pain, having choked and vomited following the ingestion of steak. Computed tomograpy scan of the thorax demonstrated a large pneumomediastinum associated with an oesophageal perforation on the anterior wall and bilateral pleural effusions. A primary laparoscopic repair was performed with jejunostomy placement for feeding. The post-operative period was complicated by a prolonged stay on intensive care with sepsis secondary to mediastinitis. A contrast swallow performed eleven days post-surgery confirmed no persistent leak and the patient was discharged five days later. Boerhaave’s syndrome accounts for 10% of oesophageal perforations and is typically associated with a history of overindulgence and vomiting. Stable patients with a contained disruption and minimal contamination, can be managed conservatively. Endoscopic therapies include clipping small perforations, self-expanding stents for larger defects, and endoluminal vacuum therapy. Operative interventions comprise primary repair, debridement and drainage of thoracic cavity, diversion operations and single stage resection with or without primary reconstruction. Conclusion Boerhaave’s Syndrome is associated with significant morbidity and mortality, but with early recognition and prompt intervention, patients can be successfully managed. Options include conservative, endoscopic and surgical, depending upon the site and size of the perforation.

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Alternative management of delayed spontaneous oesophageal perforation by endoscopic stenting

BMJ Case Reports ◽

10.1136/bcr-2021-244122 ◽

2021 ◽

Vol 14 (7) ◽

pp. e244122

Author(s):

Christina Zhu ◽

Adan Castrodad ◽

Ariel P Santos

Keyword(s):

Primary Repair ◽

Delayed Diagnosis ◽

Tube Placement ◽

Oesophageal Perforation ◽

Endoscopic Stenting ◽

Boerhaave’S Syndrome ◽

Alternative Management ◽

Boerhaave's Syndrome ◽

Endoscopic Gastrostomy ◽

Threatening Condition

Boerhaave’s syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%–50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave’s syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.

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AB006. 74. Thoracoscopic debridement and primary repair of spontaneous oesophageal perforation (Boerhaave’s syndrome)

Mesentery and Peritoneum ◽

10.21037/map.2018.ab006 ◽

2018 ◽

Vol 2 ◽

pp. AB006-AB006

Author(s):

Jessie A. Elliott ◽

Louise Buckley ◽

Thomas J. Murphy

Keyword(s):

Primary Repair ◽

Oesophageal Perforation ◽

Boerhaave’S Syndrome ◽

Boerhaave's Syndrome

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Complicated Boerhaave’s Syndrome Managed by Conservative Treatment

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1930671 ◽

2020 ◽

pp. 61-65

Author(s):

S. D. Peter ◽

A. H. Shitta ◽

J. M. Njem ◽

E. O. Igoh ◽

A. F. Ale ◽

...

Keyword(s):

Pleural Effusion ◽

Conservative Treatment ◽

Parenteral Nutrition ◽

Early Recognition ◽

Tube Thoracostomy ◽

High Morbidity ◽

Full Thickness ◽

Boerhaave’S Syndrome ◽

Severe Condition ◽

Boerhaave's Syndrome

Boerhaave’s syndrome is a full-thickness perforation of oesophagus associated with vomiting and/or severe straining. It is a severe condition with high morbidity and mortality; the outcome is dependent on early recognition, prompt and effective intervention. It commonly presents early with mediastinitis or pleural effusion. Though uncommon, it can present late with severe chest complications which are usually managed aggressively. The present study reports a 41-year old Nigerian man with Boerhaave’s syndrome who presented with left pneumohydrothorax who was successfully managed with chest tube thoracostomy drainage and parenteral nutrition.

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ENDOSCOPIC CLOSURE OF GIANT ESOPHAGEAL PERFORATION IN BOERHAAVE'S SYNDROME USING SPONGE AND VACUUM THERAPY

10.1055/s-0038-1637247 ◽

2018 ◽

Author(s):

G Loske ◽

A Martinez-Alcala ◽

LC Fry ◽

K Mönkemüller

Keyword(s):

Esophageal Perforation ◽

Vacuum Therapy ◽

Boerhaave’S Syndrome ◽

Boerhaave's Syndrome ◽

Endoscopic Closure

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Outcomes following Boerhaave’ syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.557 ◽

2013 ◽

Vol 95 (8) ◽

pp. 557-560 ◽

Cited By ~ 2

Author(s):

CL Connelly ◽

PJ Lamb ◽

S Paterson-Brown

Keyword(s):

Hospital Stay ◽

Primary Repair ◽

Length Of Hospital Stay ◽

Good Survival ◽

Boerhaave’S Syndrome ◽

Direct Closure ◽

Tube Drainage ◽

T Tube ◽

Boerhaave's Syndrome ◽

The Mean

Introduction Boerhaave’s syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. Methods Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. Results Twenty patients with Boerhaave’s syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. Conclusions Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave’s syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.

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Endoscopic intracavitary vacuum therapy of Boerhaave's syndrome: a case report

Endoscopy ◽

10.1055/s-0029-1244092 ◽

2010 ◽

Vol 42 (S 02) ◽

pp. E144-E145 ◽

Cited By ~ 3

Author(s):

G. Loske ◽

T. Schorsch ◽

C. Müller

Keyword(s):

Case Report ◽

Vacuum Therapy ◽

Boerhaave’S Syndrome ◽

Boerhaave's Syndrome

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Third time recurrent Boerhaave’s syndrome: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02779-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Adam Zeyara ◽

Martin Jeremiasen ◽

Oscar Åkesson ◽

Dan Falkenback ◽

Michael Hermansson ◽

...

Keyword(s):

Early Diagnosis ◽

Stent Placement ◽

Recurrent Disease ◽

Primary Repair ◽

English Literature ◽

White Male ◽

Esophageal Disease ◽

Boerhaave’S Syndrome ◽

Vacuum Assisted Closure ◽

Boerhaave's Syndrome

Abstract Background Effort rupture of the esophagus or Boerhaave’s syndrome is a rare entity, and prognosis is largely dependent on early diagnosis and treatment. Recurrent effort ruptures are very rare, only reported in a few case reports in English literature. We present a case with a third time effort rupture, and to the best of our knowledge there are no such previous publications. Furthermore, the presented case is also distinct because each episode was treated by different methods, reflecting the pathophysiology of recurrent disease as well as the last decade’s advancements in the management of esophageal perforations in our clinic and globally. Case presentation The patient is a 60-year-old White male, suffering from alcohol abuse, mild reflux esophagitis, and a history of effort esophageal ruptures on two previous occasions. He was now admitted to our ward once again because of a third bout of Boerhaave’s syndrome. The first time, 10 years ago, he was managed by thoracotomy and laparotomy with primary repair, and the second time, 5 years ago, by transhiatal mediastinal drainage through a laparotomy and endoscopic stent placement. Now he was successfully managed by endovascular vacuum-assisted closure therapy alone. Conclusions Recurrent cases of Boerhaave’s syndrome are very rare, and treatment must be tailored individually. The basic rationale is, however, no different from primary disease: (1) early diagnosis, (2) adequate drainage of extraesophageal contamination, and (3) restoration of esophageal integrity. Recurrent disease is usually contained and exceptionally suitable for primary endoscopic treatment. To cover the full panorama and difficult nature of complex esophageal disease, endoscopic modalities such as stent placement and endovascular vacuum-assisted closure, as well as the capacity for prompt extensive surgical interventions such as esophagectomy, should be readily accessible within every modern esophageal center.

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