Boerhaave's Syndrome: Still a Diagnostic and Therapeutic Challenge in the 21st Century

Spapen, Jerrold; Regt, Jouke De; Nieboer, Koenraad; Verfaillie, Guy; Honoré, PM; Spapen, Herbert

doi:10.1155/2013/161286

Cited by 26 publications

(61 citation statements)

References 13 publications

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“…previous chest procedures. According to the cited authors the comparison of the open technique with the thoracoscopic one in the treatment of early cases of BS shows that the latter technique allows for better visualisation of the extent of the damage, significantly reduces surgical trauma, blood loss and postoperative pain, substantially improves ventilation and lasts shorter than classic surgery (18,21). The authors of the cited reports suggest that VATS enables one to achieve similar results as the open technique and will soon replace it.…”

Section: Endoscopic Treatment Video Assisted Thoracic Surgery (Vats)mentioning

confidence: 99%

“…After nearly 70 years from the first effective reconstructions of a ruptured oesophagus performed by Barrett (16) as well as Olson and Clagett (17), multiple strategies for the treatment of BS can be found in medical literature, from symptomatic treatment to treatment as radical as oesophagectomy (18). The choice of the right method of treatment adjusted to the stage of mediastinal and pleural infection is still a very difficult issue.…”

mentioning

confidence: 99%

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Boerhaave’s Syndrome – Over 290 Yrs of Surgical Experiences. Surgical, Endoscopic and Conservative Treatment

Rokicki¹,

Rokicki²,

Rydel³

2016

Polish Journal of Surgery

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Section: Endoscopic Treatment Video Assisted Thoracic Surgery (Vats)mentioning

confidence: 99%

mentioning

confidence: 99%

Boerhaave’s Syndrome – Over 290 Yrs of Surgical Experiences. Surgical, Endoscopic and Conservative Treatment

Rokicki¹,

Rokicki²,

Rydel³

2016

Polish Journal of Surgery

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“…The treatment options for Boerhaave's syndrome include conservative management, endoscopy or surgery 10. The decision is taken based on how long diagnosis was delayed, general patient condition and the extent of the tear.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome

et al. 2016

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A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces. A diagnosis of Boerhaave's syndrome was made. The patient was transferred to the intensive care unit but did not survive. This case demonstrates the importance of looking for and treating the rarer reversible causes of cardiac arrest, and of maintaining a high index of suspicion for Boerhaave's syndrome. Despite its rarity, Boerhaave's syndrome is often misdiagnosed on initial presentation, leading to delayed treatment and poor outcomes.

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“…Spapen et al [9] and de Schipper et al [10] provide excellent algorithms; however, reiterated again is the emphasis for a case-by-case management approach.…”

Section: Discussionmentioning

confidence: 99%

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

Baird¹,

Norinsky²

2016

World Journal of Emergency Medicine

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Here we present the case of a 20-year-old male with a known history of an artificial mechanical aortic valve replacement at ages four and twelve, on chronic warfarin therapy, who presented to our community emergency department for the evaluation of vomiting, diarrhea, generalized malaise and abdominal pain. He was seen at a local urgent care for similar symptoms earlier in the day, subsequently discharged with a diagnosis of mild gastroenteritis; however, according to the patient's sister, upon his return home he looked very unwell and she called an ambulance immediately. He stated the vomiting was nonbloody, nonbilious and without a coffee-ground appearance; the diarrhea likewise was nonbloody, nonmelenic, but mucousy. He had chills, but denies recent fevers, urinary complaints, back pain, chest pain, cough, or dyspnea. No recent illnesses, sick contacts, or travel. The patient denied any other medical or surgical history. Importantly, the patient reported no recent adjustments in his warfarin dose, admitted compliance, with last INR 2.1 two days prior to presentation.He was immediately brought to an examination room for evaluation (ESI level 1) and upon initial presentation was found to be toxic-appearing. Initial vital signs were as follows: blood pressure 88/52 mmHg, pulse rate 138 beats/minute, breathing 32 respirations/minute, a rectal temperature of 94.2 degrees Fahrenheit, and saturating 91% on ambient air. He was ashen, with sunken eyes and dry mucous membranes. Conjunctivae were pale. Cardiopulmonary exam was significant for tachypnea, tachycardia, and a systolic murmur consistent with his history of aortic valve replacement. Abdomen was soft, nondistended, diffusely tender without particular focal tenderness in any quadrant, and hypoactive bowel sounds, without peritoneal signs of guarding, rebound, or rigidity. Rectal examination revealed no gross or microscopic blood. Peripheral pulses were weak but palpable in the radial and femoral arteries. The remaining physical examination was unremarkable.Given his significant presentation and past medical history, an extensive work-up was immediately undertaken specifically focusing on inflammatory markers, bleeding studies, and imaging of the abdomen. The patient was mentating, had no signs of impending airway or breathing decompensation. Nursing staff was instructed to place two large-bore intravenous lines, with two boluses of warmed normal saline and to cover the patient with a Bair hugger. An emergent bedside ultrasound of the abdomen via RUSH protocol (rapid ultrasound for shock/hypotension) was performed by the emergency physicians, revealing a moderateto-large amount of intra-abdominal free fluid in the splenorenal, hepatorenal, and perivesicular spaces; the inferior vena cava was fully collapsed; the left ventricle was hyperdynamic; there was no evidence of pericardial effusion, abdominal aortic aneurysm or dissection. A bedside chest radiograph revealed no evidence of infi ltrates or pleural effusions, subdiaphragmatic free air, pneumothorax, or any...

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Boerhaave's Syndrome: Still a Diagnostic and Therapeutic Challenge in the 21st Century

Cited by 26 publications

References 13 publications

Boerhaave’s Syndrome – Over 290 Yrs of Surgical Experiences. Surgical, Endoscopic and Conservative Treatment

Boerhaave’s Syndrome – Over 290 Yrs of Surgical Experiences. Surgical, Endoscopic and Conservative Treatment

Cardiac arrest due to a missed diagnosis of Boerhaave's syndrome

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

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