Diagnosis and management of spontaneous transmural rupture of the oesophagus (Boerhaave's syndrome)

Walker, William S.; Cameron, Evan Wm.; Walbaum, P. R.

doi:10.1002/bjs.1800720320

Cited by 92 publications

(76 citation statements)

References 27 publications

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“…Surgical treatment of spontaneous esophageal rupture involves suture closure of the perforation itself, adequate irrigation of the thoracic and mediastinal cavities, and appropriate drainage 16,17) . Because the rupture frequently occurs in the left wall of the lower esophagus, a left thoracotomy approach is commonly used during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…We believe, then, that when surgery is performed 48 hours or more after symptom onset in patients with extensive intrathoracic contamination and crush injuries to the perforated tissues, esophagectomy and late reconstruction can ensure survival. Furthermore, gastrostomy or enterostomy creation is useful for patients in this condition, which is associated with a high rate of postoperative anastomotic leakage, so that enteral nutrition can be given postoperatively 16) . In recent years, there have been scattered reports of treatment of spontaneous esophageal rupture by video-assisted thoracoscopic surgery (VATS) 21) .…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Mikami

Fukunaga

Enomoto

et al. 2015

J St. Marianna Univ

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Spontaneous esophageal rupture is rare. The distal esophagus ruptures upon a sudden vomiting-induced increase in the internal esophageal pressure. We evaluated surgical management of spontaneous esophageal rupture by examining clinical details and outcomes of 10 patients treated for the disorder at our hospital between 1987 and 2014.Mean age of the patients was 58.1 years (range, 41-75 years). The sex ratio (M/F) was 9/1. Diagnosis was achieved by chest computed tomography (CT) or chest CT and esophagography. The rupture occurred in the left lower thoracic esophagus (n=8), left middle thoracic esophagus (n=1), or right lower thoracic esophagus (n=1). Mean time from symptom onset to surgery was 36.2 hours (range, 5-96 hours).Patients were divided between those treated within 24 hours of onset (early treatment group, n=5) and those treated 24 hours or more after onset (late treatment group, n=5). Treatment comprised primary repair in 7 patients and esophagectomy in 3. Postoperative complications occurred in 6 patients: surgical site infection (n=4), anastomosis leakage (n=3), intrapleural abscess (n=1), sepsis (n=1), and pneumonia (n=1). Mean postoperative hospital stay was78.5 days (range, 22-228 days). There was no in-hospital mortality.Postoperative complications were somewhat more frequent in the late treatment group (n=4, 80%) than in the early treatment group (n=3, 60%), and postoperative hospital stay was longer in this group (114.2 vs. 42.8 days). Outcomes in terms of postoperative complications and hospital stay were good in the early treatment group. In the late treatment group, severe intrathoracic contamination in 3 patients necessitated life-saving esophagectomy. When primary repair was performed, the incidence of anastomotic leakage was lowest when both layers were sutured, perforation sites were reinforced, and nutritional support was provided.Early diagnosis and treatment are essential for spontaneous esophageal rupture, and we believe that selecting the appropriate surgical technique increases survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Mikami

Fukunaga

Enomoto

et al. 2015

J St. Marianna Univ

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“…The classic clinicaI triad includes: vomiting, pain in the chest and subcutaneous emphysema. 13 Other abnormalities exhibiting pain in the chest or the upper abdomen and vomiting may be confounded with the syndrome; among them, we can consider myocardiac ischemia, perforated peptic ulcer and acute pancreatitis, dissecting aortal aneurysm and aspiration pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the esophagus: report of two cases

et al. 1997

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OBJECTIVE - To study the diagnosis, prognosis and management of spontaneous rupture of the esophagus. DESIGN: This is a retrospective study through the analysis of two cases with delayed diagnosis and subsequent treatment at the Track Surgery Service. LOCALE: The study was performed at the Thoracic Surgery Unit of the Hospital do Servidor Público Estadual Francisco Morato de Oliveira in the city of São Paulo. This is a specialized service. PARTICIPANTS: The two patients reported on had suffered spontaneous rupture of the esophagus. They were transferred to the Thoracic Surgery Unit because of the worsening of their condition in the previous institution which they had been admitted into. MEASUREMENT: The two patients with esophagus pleural fistula received similar treatment, initially advocated by Kanashin in Russia and Hauer-Santos in the United States, which consists of washing the fistula and using continuous pleural aspiration. RESULTS: Although both patients had to spend a long period of time in hospital, their evolution was satisfactory with the treatment adopted, and the fistula closed. CONCLUSION: The authors conclude that the method of lavage of the mediastinum and continuous pleural aspiration, in patients who after spontaneous rupture of the esophagus developed a pleural esophagus fistula due to belated diagnosis, is an alternative and satisfactory therapy. Furthermore, in order to have the best outcome, an early diagnosis is recommended and thoracostomy as the surgical procedure, with primary suture.

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“…4 It may occur in all age groups, from neonates to elderly individuals, but is most frequent in middle-aged males. 5 The syndrome usually results from an increase in the intraluminal esophageal pressure, frequently associated with excessive consumption of alcohol and food followed by vomiting. The sudden rise in the intraluminal esophageal pressure tears the distal, left lateral esophageal wall 3 to 5 cm above the gastroesophageal junction.…”

Section: Objectifmentioning

confidence: 99%

Perioperative management of a patient presenting with a spontaneously ruptured esophagus

Pandey

Bose

Dash

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report a case of spontaneous rupture of the esophagus and its anesthetic management. C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 52-yr-old male presented with a seven day history of chest pain, respiratory distress, and swelling in the neck following forceful vomiting. Examination revealed hypotension, decreased air entry in the right lower lung field with crepitations, epigastric tenderness with abdominal distension and guarding of both right and left hypochondria. A contrast esophagogram showed extravasation of contrast material from the lower third of the esophagus into the mediastinum without pleural cavity involvement. Reinforced primary closure of a 5-cm transmural tear in the right anterolateral wall of the esophagus 5 cm above the gastroesophageal junction was performed along with right-sided chest drainage.The anesthetic drugs and technique in this case were selected to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. Invasive monitoring was used to assess early hemodynamic changes and to administer fluid therapy and vasoactive drugs. Due to prolonged surgery, lung congestion, large fluid shifts, a long surgical incision and abnormal arterial blood gases, the patient was ventilated mechanically in the intensive care unit. Subsequently he developed an esophageal leak, septic shock, and multiple organ failure and died. C Co on nc cl lu us si io on n: : In a patient with a spontaneous rupture of esophagus, the anesthetic considerations include avoidance of further aggravation of the esophageal tear, and resuscitation from a morbid inflammatory condition. Objectif

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Diagnosis and management of spontaneous transmural rupture of the oesophagus (Boerhaave's syndrome)

Cited by 92 publications

References 27 publications

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Spontaneous rupture of the esophagus: report of two cases

Perioperative management of a patient presenting with a spontaneously ruptured esophagus

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