Management of spontaneous rupture of the oesophagus (Boerhaave’s syndrome): Single centre experience of 18 cases

Prichard, Ruth; Butt, Jamal; AI-Sariff, N.; Fröhlich, Stephen; Murphy, Stephen; Manning, Brian J.; Ravi, Narayanasamy; Reynolds, John V.

doi:10.1007/bf03167971

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…Most case series of esophageal perforation come from central teaching hospitals, only a few of which are from the UK 1,12–14 . Therefore, our aim was to perform a 13‐year retrospective review of the cases managed in our peripheral district general hospital.…”

Section: Introductionmentioning

confidence: 99%

“…11 Most case series of esophageal perforation come from central teaching hospitals, only a few of which are from the UK. 1,[12][13][14] Therefore, our aim was to perform a 13-year retrospective review of the cases managed in our peripheral district general hospital. Our purpose was to learn more about the management of esophageal perforation in the era of improved diagnostic imaging and access to a wide variety of potential surgical and nonsurgical treatment options.…”

Section: Introductionmentioning

confidence: 99%

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Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Griffiths

Yap

Poulter

et al. 2009

Diseases of the Esophagus

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Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Griffiths

Yap

Poulter

et al. 2009

Diseases of the Esophagus

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“…Some advocate primary surgical repair as the gold standard treatment in all patients able to tolerate surgery, with best outcomes when performed within 24 h 3 17. Some studies, however, suggest surgery beyond 24 h may still improve outcome and reduce mortality 18–20.…”

Section: Discussionmentioning

confidence: 99%

Another case of chest pain on the acute medical take!: Figure 1

White

2012

BMJ Case Reports

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SummaryA physiologically fit 91-year-old gentleman presented with sudden onset chest pain, breathlessness and cardiovascular compromise associated with vomiting. He was treated for renal colic, community-acquired pneumonia and pulmonary embolism before a formal diagnosis of Boerhaave's syndrome was made. The patient was prepared for emergency surgery, unfortunately his condition deteriorated rapidly and he was subsequently managed conservatively. He died 2 days later. Diagnosis and treatment of Boerhaave's syndrome are often delayed. Treatment options for Boerhaave's syndrome include conservative measures, endoscopic interventions and surgery. Chest pain is a common presentation on the acute medical take. Boerhaave's syndrome is a rare cause of chest pain, which may mimic other conditions but should not be missed due a high death rate. BACKGROUND

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“…Postoperative leakage happened in four cases and two died of uncontrolled sepsis, but only one died after primary repair. The fact gives us reason to propose: regardless of the time delay, transthoracic primary repair should be the first choice for treating BS patients; other techniques, such as drainage alone, exclusion and diversion, or esophageal resection may be appropriate in certain circumstances 6,10,14,48–50 …”

Section: Discussionmentioning

confidence: 99%

“…The fact gives us reason to propose: regardless of the time delay, transthoracic primary repair should be the first choice for treating BS patients; other techniques, such as drainage alone, exclusion and diversion, or esophageal resection may be appropriate in certain circumstances. 6,10,14,[48][49][50] Although, some reported that selected esophageal laceration might not need repair if only the pleural effusion had been drained thoroughly and the infection had been controlled completely. 10,49,51,52 Our experience showed that esophageal tear is hard to heal spontaneously as the infection is hard to control when negative intrathoracic pressure and mechanical movement of the chest during ventilation ensures dissipation of these toxic substances within the mediastinum and pleura.…”

Section: Discussionmentioning

confidence: 99%

Our experience on management of Boerhaave's syndrome with late presentation

Wang

Zhang

Zhou

et al. 2009

Diseases of the Esophagus

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A retrospective review of 18 patients treated for Boerhaave's syndrome in our center from 1954 to 2006 was undertaken. The patients were divided into two groups: group 1, the time delayed before treatment was less than 24 hours; group 2, the time delayed was more than 24 hours. The time interval between perforation and the onset of treatment in group 2 was from 50 hours to 30 days. Roentgenograms of the chest and esophagogram with a water-soluble contrast medium are able to reveal the perforation in most cases, and thoracentesis or thoracic drainage after swallow methylene blue may provide help as well. Surgical intervention was adopted in all three patients in group 1 and 12 in group 2, and conservative intervention in three in group 2. In group 1, two patients recovered uneventfully, the other one developed a postoperative respiratory infection, and he recovered after the infection was controlled. The mortality in group 2 was 33.3% (5/15), and the mortality in patients with conservative intervention was 100% (3/3). Five complications occurred after surgical intervention in group 2, including four fistulae and one incision infection. In conclusion, it may be appropriate to manage patients aggressively with primary repair and adequate mediastinal and pleural drainage when patients present late. Because of the syndrome's initial severity and a tendency to postoperative complications, patients should be closely monitored, and correct antibiotic therapy and adequate nutrition are very important in treatment.

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Management of spontaneous rupture of the oesophagus (Boerhaave’s syndrome): Single centre experience of 18 cases

Abstract: Surgical intervention remains the gold standard when the diagnosis is made early. For late diagnoses, this series suggests caution in the use of endoprostheses.

Cited by 7 publications

References 13 publications

Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Another case of chest pain on the acute medical take!: Figure 1

Our experience on management of Boerhaave's syndrome with late presentation

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