Boerhaave Syndrome Causing Bilateral Empyemas

Chalikonda, Divya; Yoo, Joseph; Johnson, Drew; Tofani, Christina

doi:10.14309/crj.0000000000000203

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Anwuzia-Iwegbu et al reported a successful case of conservative management, as their patient exhibited a contained leak, absence of underlying esophageal pathology, and minimal symptoms or signs of sepsis [3]. Endoscopic intervention may be indicated in stable patients with early presentation, lesions smaller than 1 cm, an experienced team, and potentially in patients who are not suitable for surgery due to significant comorbidities [1,2]. Endoscopic treatments include the placement of clips, stents, or prostheses, and, as a last resort, suturing [9].…”

Section: Discussionmentioning

confidence: 99%

A Conservative and Multidisciplinary Approach to Boerhaave Syndrome: A Case Report

Ribeiro,

Cardoso,

Santos

2024

Cureus

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Boerhaave's syndrome is a life-threatening spontaneous esophageal rupture, usually in its distal part. It generally develops after situations that suddenly increase the intraesophageal pressure, such as, during or after persistent vomiting. Despite it being a rare condition in clinical practice, it has a high mortality rate (18-39%). Treatment can be approached conservatively, endoscopically, or surgically. The more invasive the treatment, the worse the prognosis. This paper presents a healthy 62-year-old man who resorted to the emergency department complaining of lower back and left scapular pain, after two non-bilious episodes of vomiting. There was no history of any trauma, vigorous physical exercise or previous similar episodes. He was alert, hemodynamically stable, and without any airway compromise or respiratory distress. At the physical exam, non-painful subcutaneous crepitations were palpable in the left cervical region without palpable masses. Chest examination finds reduced air entry on the left pulmonary base. Hence, Boerhaave's syndrome was suspected. CT scan revealed a pneumomediastinum and a left pulmonary collection. Oxygen therapy, blood cultures, empirical antibiotic therapy, and thoracic tube drainage were performed. The upper digestive endoscopy revealed the perforation in the distal esophagus, and an over-the-scope clip, a covered endoprosthesis and nasojejunal tube feeding were placed.The patient was admitted to the Intermediate Care Unit for stabilization. He was discharged home on the 33 rd day and remains well at two months of follow-up.Delayed diagnosis and treatment are the principal causes of high mortality in Boerhaave's syndrome. There is no standard treatment option. In this case report, given the patient's stable clinical condition, the authors used a non-surgical conservative treatment, allowing for a delayed esophageal repair.

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Section: Discussionmentioning

confidence: 99%

A Conservative and Multidisciplinary Approach to Boerhaave Syndrome: A Case Report

Ribeiro,

Cardoso,

Santos

2024

Cureus

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“…8 There are only two reports of development of bilateral empyema in patients with Boerhaave syndrome. 9,10 Intervention is indicated in patients who have empyema, are clinically deteriorating, or if there is progression of pneumomediastinum or pneumothorax. 11,12…”

Section: Discussionmentioning

confidence: 99%

Boerhaave Syndrome: An Uncommon Cause of Hydropneumothorax

Sivakumar¹,

Chandrasekhar²,

Mounika³

et al. 2022

The Indian Journal of Chest Diseases and Allied Sciences

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We report the case of a 52-year-old patient with type 2 diabetes mellitus diagnosed with adenocarcinoma rectum, presenting with the complaint of breathlessness to the emergency department. Chest radiograph done showed a left-sided hydropneumothorax with mediastinal shift to the right side. Tube thoracostomy was done. Pleural fluid was exudative; there was no evidence of malignancy. The patient developed a right-sided pleural effusion; anaerobic bacteria were grown on pleural fluid culture. Computed tomography (CT) of the chest was done in view of the new onset empyema on the right side. The CT showed pneumomediastinum and periesophageal air pockets. Orally administered methylene blue had appeared in the pleural drain confirming the diagnosis. The patient was taken up for feeding jejunostomy and repair of tear was planned for a later date. He succumbed to sepsis due to empyema.

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“…Several anatomical factors play a role in this predilection, including the organization of the submucosal muscular layer, connective tissue architecture, penetrating neurovascular bundles, and fewer surrounding organs on the left esophageal wall. The left posterolateral wall of the distal esophagus is considered the most common site for perforation with a predilection for left-sided pleural effusion, whereas right-sided effusion is suggested to have a high likelihood for mid-esophagus tear [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Catastrophic right-sided Candida empyema from spontaneous esophageal perforation

Jahangir

Sahra

Anwar

et al. 2021

Respiratory Medicine Case Reports

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Right-sided empyema secondary to esophageal rupture are rare but reported in the medical literature. We describe an atypical CASE of right-sided empyema with Candida Tropicalis, Candida Glabrata , and Staphylococcus lugdenensis leading to a diagnosis of spontaneous esophageal rupture. We concluded that pleural effusion with fungal and multi-organism growth should immediately raise suspicion for underlying missed esophageal perforation. Prompt diagnosis of esophageal perforation can prevent fatal complications like pleuritis, pneumothorax, hydrothorax, pneumomediastinum, mediastinitis, acute respiratory distress syndrome, and septic shock.

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Boerhaave Syndrome Causing Bilateral Empyemas

Cited by 8 publications

References 16 publications

A Conservative and Multidisciplinary Approach to Boerhaave Syndrome: A Case Report

A Conservative and Multidisciplinary Approach to Boerhaave Syndrome: A Case Report

Boerhaave Syndrome: An Uncommon Cause of Hydropneumothorax

Catastrophic right-sided Candida empyema from spontaneous esophageal perforation

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