Boerhaave's syndrome: 10 years experience and review of the literature

Abstract

Boerhaave's syndrome is rare and its management is not uniform. A review of the literature demonstrates wide disparity in management due to the rarity of the condition. Primary repair is appropriate for ruptures diagnosed early. Many are diagnosed late and T-tube drainage may be the simplest way to manage this difficult condition in this situation.

The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome) ‒ 20 years of experience

“…This feature is observed in about 90% of the cases (1)(2)(3)8,(11)(12)(13)(14). The mucosal injury is usually longer and extends beyond the muscular tear, and this has important implication for the technical aspects of the repair (14,15). The mediastinum and often one or both pleural cavities become thus infected.…”

“…Nutrition is an important aspect of treatment in patients presenting with esophageal perforation therefore, besides primary esophageal repair drainage gastrostomy and above all feeding jejunostomy are useful adjunctive options that should be strongly considered during the operative procedure (3,6,11,14,16,17,25,28). In our study, adequate nutritional support was performed through a nasal feeding tube or a jejunostomy in all cases.…”

“…Left untreated it is very often a fatal condition with overhelming mediastinitis, respiratory failure, shock, sepsis and early death (1,8,9,(16)(17)(18). The disease is more frequently observed in adult patients with an history of chronic alcoholic abuse and with a strong male predominance (2,8,10,14).…”

Acute Respiratory Failure in a Patient With Spontaneous Esophageal Rupture (Boerhaave Syndrome)

“…Hill et al found an approximate incidence of one in 53,000 of all hospital admissions. 2 Spontaneous esophageal ruptures are less common than iatrogenic and traumatic esophageal ruptures, and account for 15-40% of all esophageal perforations. [3][4][5][6] Boerhaave syndrome usually occurs in patients 40 -60 years old, but has also been reported in neonates and the elderly.…”

Management of Boerhaave’s Syndrome

“…In approximately 90% of the cases, the area of perforation and contrast leak is at the left posterolateral aspect of the distal third of the oesophagus, usually within 2-3 cm above the oesophagogastric junction. 8 The complication risk of endoscopic assessment (OGD) is minimal and it excludes the diagnosis if normal. It also influences the management if underlying pathology, such as cancer is found and facilitates placement of nasojejunal feeding tube if required.…”