Boerhaave Syndrome

Vest, Michael T.; Dross, Peter

doi:10.7556/jaoa.2018.165

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Boerhaave’s syndrome is defined as spontaneous esophageal rupture due to sudden increase in esophageal pressure accompanied by inability of the cricopharyngeal sphincter to relax [ 4 ]. It is a rare but life-threatening condition, for absence of mucous muscularity in esophagus allows food remains and gastric juices to enter the mediastinum, resulting in extensive infection of the mediastinum and pleural cavities without proper treatment.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

Wang

Chen

2021

J Med Case Reports

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Background Boerhaave’s syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. Case presentation Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. Conclusions We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

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Section: Discussionmentioning

confidence: 99%

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

Wang

Chen

2021

J Med Case Reports

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“…Boerhaave's syndrome is de ned as spontaneous esophageal rupture due to sudden increase in esophageal pressure accompanied by inability of the cricopharyngeal sphincter relaxation [4]. It is a rare but life-threatening condition, for absence of mucous muscularity in esophagus allows food remains and gastric juices to enter into the mediastinum, resulting in extensive infection of the mediastinum and pleural cavities if without proper treatment.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

Wang

Wang²,

Chen

2020

Preprint

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BACKGROUND: Boerhaave’s syndrome is the spontaneous rupture of the esophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality, which is why it requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging.CASE PRESENTATION: Case one: A 54-year-old man presented to us with sudden-onset epigastric pain radiating to the back following hematemes. His previous medical history included gastric ulcer. His physical signs suggested early shock. Combined with his medical history and physical signs, emergency doctor suspected a diagnosis of peptic ulcer with hematemesis, and esophagegastroscopy was performed. However, upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. The subsequent computed tomography (CT) showed frank pneumomediastinum and heterogeneous pleural effusion. He was subsequently referred to us in view of suspected Boerhaave’s syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Esophageal perforation repair operation and jejunostomy was performed for him. The postoperative period was uneventful, and he was discharged.Case two: A 62-year-old man was admitted to the emergency department with thoracic dull pain and chest distress that started after he had been vomiting several hours before presentation. On physical examination, he presented rough bronchovesicular breathing sound, and crepitant rales in lungs prompting subcutaneous emphysema. Chest CT scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Therefore, spontaneous esophageal perforation was suspected. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His vital signs remained stable intraoperatively, and his postoperative periods were uneventful with no leakage or stricture. Case three: The patient was a 69-year old male presenting with a severe retrosternal and upper abdominal pain followed an episode of forceful vomiting. At admission, he was diaphoretic and in respiratory distress. Physical examination revealed extensive cervical and thoracic subcutaneous emphysema but was otherwise unremarkable. A thoracic CT scan revealed a rupture in the left distal part of the oesophagus, a pneumomediastinum and left-sided pleural effusions. Conservative treatment, with cessation of oral intake, nasogastric suction, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum anti-biotics, proton pump inhibitors and drainage of the pleural effusion by left-sided thoracostomy, failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery.CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

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“…Деякі автори вважають, що пересічення шийного відділу стравоходу показано лише при стравохідно-трахеальних норицях [11]. Проте в нашій роботі ми рідко проводили накладанння езофагостоми -лише в 2-х хворих.…”

Section: матеріали та методи дослідженьunclassified

Features of surgical treatment of esophageal injuries complicated by purulent mediastinitis

Shevchuk¹,

Snizhko²

2020

Medicni Perspektivi (Medical Perspectives)

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Boerhaave Syndrome

Cited by 3 publications

References 2 publications

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series

Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

Features of surgical treatment of esophageal injuries complicated by purulent mediastinitis

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