Boerhaave’s Syndrome: Delayed Management Using Over-the-Scope Clip

Abstract

Patient: Male, 43 Final Diagnosis: Boerhaave’s syndrome Symptoms: Dyspnoea • epigastric pain • vomiting Medication: — Clinical Procedure: Over-the scope-clip and pleurodesis Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: The diagnosis of Boerhaave’s syndrome is often missed or delayed. This subsequently leads to a high mortality rate, which could be greatly reduced if treatment is instituted early, within 24 hours of perforation. Treatment ranges from conservative management to operative intervention depending on the time of presentation and the patient’s clinical condition. Endoscopic intervention in the form of over-the-scope clip (OTSC) application is gaining popularity with very promising results. Case Report: A 43-year-old male was diagnosed with Boerhaave’s syndrome and treated initially by insertion of bilateral chest drainage, intravenous broad-spectrum antibiotics, and total parenteral nutrition. He was transferred to our facility 9 days later. Upper gastrointestinal endoscopy revealed a 1.5 cm deep longitudinal ulcer involving the distal esophagus and extending to the Z-line. Due to the perforation site, a size 12 OTSC clip was used. Application of a second clip was needed to achieve complete closure of the perforation site. Contrast swallow was done 4 days later showed no leak. The patient was started on oral intake and was discharged home in good general condition after a hospital stay of 16 days. Conclusions: Delayed presentation of Boerhaave’s syndrome can be treated safely by an over-the-scope clip. This endoscopic method hastens recovery and shortens the hospital stay.

Refractory cutaneo-gastric conduit fistula after esophagectomy repaired by a pectoralis major muscle flap and split-thickness skin graft

“…As the OTSC has a greater compressive force, it can be applied to larger defects and more hardened tissues [14]. The successful application of an OTSC in the treatment of esophagocutaneous fistula due to Boerhaave’s syndrome was reported [15]. However, it is difficult to maneuver the OTSC well in the narrow gastrointestinal tract lumen with a tangential view.…”

Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations

“…An upper gastrointestinal (GI) series performed 4 days after the procedure demonstrated no leaks and the patient remained well at the 6-month follow-up. 11 In another case, a 90-year-old female underwent endoscopic ultrasound and developed a 10-mm iatrogenic perforation during the procedure. An OTSC was used, and an abdominal computed tomography with oral diatrizoate meglumine and diatrizoate sodium solution (GASTROGRAFIN Ⓡ ) demonstrated no leaks.…”

“…Two OTSCs were placed to ensure complete closure. An upper gastrointestinal (GI) series performed 4 days after the procedure demonstrated no leaks and the patient remained well at the 6-month follow-up [ 11 ]. In another case, a 90-year-old female underwent endoscopic ultrasound and developed a 10-mm iatrogenic perforation during the procedure.…”

Boerhaave syndrome: A rare cause of retrosternal pain

“…30 Al-Zahir studija prezentuje pacijenta koji je primarno tretiran na konzervativni način, a konačan tretman je obuhvatalo endoskopsko plasiranje stenta. 32 I kratkoročni i dugoročni ishod ovog pacijenta je bio dobar. 32 Međutim, obzirom na rijetkost ovog sindroma je teško donijeti standardizirani protokol o načinu liječenja pacijenata.…”

“…32 I kratkoročni i dugoročni ishod ovog pacijenta je bio dobar. 32 Međutim, obzirom na rijetkost ovog sindroma je teško donijeti standardizirani protokol o načinu liječenja pacijenata. 29…”