Síndrome de Boerhaave: reporte de un caso y revisión de la literatura

Salvador-Ibarra, Ibzan Jahzeel; Pizaña-Davila, Alejandro

doi:10.24875/ciru.21000010

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…The most common symptom is chest discomfort, which is reported by 70% of patients. Other symptoms included dyspnea, dysphagia, tachycardia, fever, tachypnea, epigastric discomfort, and, in rare cases, hematemesis or other evidence of gastrointestinal bleeding, such as melenas [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of spontaneous lesions occur in men between the ages of 50 and 70. They can only affect part of the esophageal wall (as in Mallory-Weiss syndrome, which occurs at the gastro-esophageal junction) or cause a full-thickness organ rupture, which leads to BS [ 4 ]. The term "spontaneous" does not imply the absence of a triggering element but rather that the rupture is not the result of direct trauma (often produced by instrumentation or a foreign body).…”

Section: Introductionmentioning

confidence: 99%

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Boerhaave’s Syndrome: An Unusual Geriatric Presentation

Canelas Mendes,

Duarte,

Madeira Lopes

2023

Cureus

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Boerhaave's syndrome (BS) is a non-iatrogenic spontaneous esophageal perforation that, if not appropriately recognized and managed, can cause localized infections such as mediastinitis, pneumonia, and empyema, as well as systemic infections with significant morbidity and mortality rates. An autonomous 83-year-old male presented to the emergency department with a three-day history of behavioral changes. Three days earlier, the patient had a self-limited episode of cough, nonspecific thoracalgia, palpitations, prostration, and pallor. On physical examination, he was alert but had temporal disorientation, hypoxemia, and pulmonary auscultation with abolished breath sounds in the middle third of the left chest. Laboratory tests showed hypoxemia, elevated C-reactive protein (28.2 mg/dL), and D-dimer (3.28 µg/mL). A chest X-ray revealed periaortic small bubbles, left atelectasis, and left pleural effusion. Computed tomographic angiography of the chest showed infra-carinal esophageal rupture, small bubbles of the anterior pneumomediastinum, and a loculated left pleural empyema. Mediastinitis and empyema due to BS were assumed. He underwent left thoracic drainage, broad-spectrum antibiotics, and the placement of a surgical esophageal prosthesis. He was discharged after 48 days. The condition known as BS is frequently misdiagnosed, mostly as a result of the lack of a preexisting pathological background and the wide array of potential symptoms that may manifest. The diagnosis in this particular case was rendered particularly complex due to the combination of an unusual presentation and a delayed seeking of medical attention. Against all expectations, our patient was successfully treated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Boerhaave’s Syndrome: An Unusual Geriatric Presentation

Canelas Mendes,

Duarte,

Madeira Lopes

2023

Cureus

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Problematic issues of diagnosis and treatment of Boerhaave’s syndrome

Zhukovskiy,

Trutyak,

Pidhirnyi

et al. 2024

ЕМ

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Boerhaave’s syndrome is a rare disease with an incidence of 3.1/1,000,000 per year, has a high mortality rate due to late diagnosis and difficulty in treatment. The purpose of the message is to draw the attention of doctors to the variety of clinical manifestations of Boerhaave’s syndrome, which complicates early diagnosis and decision making. Clinical observation of two patients with Boerhaave’s syndrome is presented. One patient was hospitalized 7 hours after the onset of pain in the upper left side, nausea, vomiting. Clinical examination, ultrasound and chest X-ray revealed no pathology. However, after 3 hours, the patient’s condition deteriorated sharply, emphysema of the neck and chest appeared. X-ray revealed left-sided pneumohemothorax. Thoracotomy revealed a 3.5-cm long rupture in the lower third of the esophagus on its left lateral wall, which was sutured. The chest cavity and mediastinum are debrided and drained using tubes. A gastrostomy was formed. The postoperative period was complicated by multiple organ failure and sepsis. Patient was in the intensive care unit for 29 days. The esophageal wound healed on the 46th day and the patient was discharged for outpatient observation. Another patient was hospitalized three hours after onset of illness with a left-sided pneumohemothorax and acute abdomen symptoms. Chest tube on the left was placed and a dark brown liquid released under pressure. The peritonitis clinical symptoms prompted surgeons to perform urgent laparotomy during which no pathology of the abdominal organs was detected. Only after computed tomography, a rupture of the esophagus was diagnosed. As a result of delayed surgery, infection complications and sepsis developed, which led to the patient’s death.

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Abordaje quirúrgico y endoscópico de un caso atípico de perforación esofágica espontánea

Giraldo-Campillo,

Jaramillo-Escobar,

Ruiz-Gallego

et al. 2024

Rev Colomb Cir

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Introducción. La perforación esofágica se define como la ruptura transmural del esófago. Existen diferentes causas, como neoplásicas, traumáticas, lesión por cuerpos extraños, ingesta de cáusticos, iatrogénicas o espontáneas, denominadas Síndrome de Boerhaave. La tasa de mortalidad es alta y oscila entre 40-60 % con manejo óptimo, hasta el 100 % sin tratamiento. Caso clínico. Se presenta el caso de una paciente de 70 años, que ingresó por 5 días de sensación de globus faríngeo, disnea y dolor torácico. Se realizó una tomografía computarizada de tórax donde se visualizó un derrame pleural derecho, que fue manejado con toracostomía cerrada. Posteriormente, se visualizó la salida de material alimentario por la sonda de toracostomía, por lo que se hizo una nueva tomografía de tórax y abdomen encontrando una fístula esofagopleural. En una esofagografía por tomografía donde se vio extravasación del medio de contraste en la región infracarinal hacia espacio pleural derecho. Resultados. Fue llevada a toracotomía, encontrando empiema y atrapamiento del lóbulo inferior derecho por abundante fibrina, pus y restos alimentarios, secundario a perforación esofágica del tercio medio. Se practicó esofagorrafia, pleurectomía y decorticación. Se continuó manejo endoscópico con sistema de vacío de forma seriada. Conclusiones. Las perforaciones esofágicas son un desafío para los cirujanos, tanto en el enfoque diagnóstico inicial, como en el tratamiento. Conocer los abordajes endoscópico, quirúrgico y mixto ayuda a ampliar las opciones de manejo en estos pacientes. El tratamiento oportuno, las indicaciones no operatorias y las nuevas medidas endoscópicas para el manejo impactan en la mortalidad.

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Síndrome de Boerhaave: reporte de un caso y revisión de la literatura

Cited by 4 publications

References 19 publications

Boerhaave’s Syndrome: An Unusual Geriatric Presentation

Boerhaave’s Syndrome: An Unusual Geriatric Presentation

Problematic issues of diagnosis and treatment of Boerhaave’s syndrome

Abordaje quirúrgico y endoscópico de un caso atípico de perforación esofágica espontánea

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