Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis

Background Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. Case presentation We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. Conclusion Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

Bovine xenograft pericardial patch use for definitive single stage repair of a large esophageal defect: a case report

Background Large esophageal perforations are challenging and often treated with exclusion or resection. This case demonstrates the feasibility of definitive surgical repair of a large esophageal perforation using large bovine pericardial patch. Case A patient with missed Boerhaave Syndrome underwent transesophageal echocardiography causing worsening perforation and sepsis. At thoracotomy and faced with a large esophageal defect, a large Bovine pericardial patch was used for repair with omentopexy. The patient recovered promptly and at 8 months was asymptomatic with satisfactory studies. Conclusion Xenograft pericardium is available and widely used for vascular reconstructions. It’s use for primary repair of large esophageal perforations should be considered.

Boerhaave syndrome in a patient with a hiatal hernia

Resumen La perforación esofágica es un proceso patológico con una alta mortalidad incluso con un diagnóstico rápido y tratamiento adecuado. Dentro de las causas de perforación esofágica, se encuentra el síndrome de Boerhaave o perforación esofágica barogénica. Presentamos el caso de un paciente de 57 años que acude a urgencias por vómitos y dolor torácico, siendo diagnosticado mediante TC de perforación esofágica. Se deben seguir los principios quirúrgicos fundamentales de diagnóstico rápido, control eficaz de la fuga, erradicación de la sepsis mediastínica y soporte óptimo en un plazo no mayor a 24 horas.