Boerhaave′s syndrome: Thoracolaparoscopic approach

Abstract

We present a case of Boerhaave’s syndrome managed thoracolaparoscopically. A 45-year- old man presented with hydropneumothorax following severe retching. He was treated with Intercostal drainage insertion as the primary management and referred to a tertiary care centre. There endoscopic stapling was attempted, following which he developed a leak. He presented to us with severe sepsis and mediastinal collection on the ninth day following the perforation. We treated him with thoracoscopic mediastinal toilet, laparoscopic-assisted feeding jejunostomy and cervical oesophagostomy. The patient was managed conservatively. A computed tomography (CT) scan was repeated at intervals of 15 days. He was continued on full jejunostomy feeds. Regular assessment of the oesophagus injury was conducted via the CT scan. The patient had complete healing of the perforation at end of two months. His oesophagostomy was closed and he remained symptom-free at follow-up. We conclude that thoracoscopy has an important role to play in the management of patients with mediastinal sepsis and late presentation of Boerhaave’s perforation.

Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

“…However, many patients develop severe postoperative sepsis and cannot be cured [10, 13]. Recently, some authors reported laparoscopy or camera-assisted surgery as a less invasive procedure than thoracotomy for treating spontaneous esophageal perforation [14–16], but these techniques require a highly skilled operator and a longer operative time, and closure of the perforation site after 24 h is more likely to lead to dysraphia [17].…”

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery

“…[11] As in the other surgical fields, minimally invasive methods (laparoscopy or thoracoscopy) have begun to be used in the treatment of oesophageal perforation. [12] Depending on the perforation area, laparoscopy may be used effectively in the distal oesophagus, and thoracoscopy can be effectively utilised in other localisations. While feeding, the jejunostomy may be opened via laparoscopic gastrostomy, but repair and drainage on a larger field in the oesophagus may be performed via thoracoscopy.…”

Primary closure of a spontaneous esophageal rupture under hand-assisted laparoscopy: a case report

“…Ashrafi et al state that indications for the minimally invasive technique for spontaneous esophageal rupture are limited to patients with stable hemodynamics, without signs of escalating sepsis, and without concomitant conditions contraindicated for surgeries, including laparoscopic or thoracoscopic surgery [ 16 ]. However, Vaidya et al reported that they selected a thoracoscopic approach for a patient with septic shock [ 19 ]. Thus, at present, there are no clear strategies for the selection of endoscopic treatment.…”