Surviving Boerhaave's Syndrome Without Thoracotomy

Approach and management modalities in Esophageal Perforations

“…1,2,6,8,12 80% of the patients have pain at the perforation site. 1,2,16 Other presenting symptoms are dysphagia, cough, vomiting, fever, hematemesis, and tachypnea. 1,2,8,12 Iatrogenic rupture is "the most common" group and may follow dilatation of a benign stricture, balloon dilatation of Achalasia, dilatation/lumenisation of carcinoma esophagus, during endoscopic mucosal resection of Barret's esophagus, Endoscopic submucosal dissection of early gastric cancers with 4% chances of early or delayed presentation of perforation, diagnostic trans esophageal echocardiography of cardiac myopathies 1 in 10,000 esophageal perforation can be seen or intra-operatively.…”

“…Otherwise the death rate was 70% or more among those who were not operated. [12][13][14][15][16][17] In the present era, conservative management has been considered in cases due to iatrogenic causes, patients who are found to be stable hemodynamically, and patients showing lesser degree of contamination of the perforation. 2 Of late, non-operative management is being advocated, more so in pediatric population, because at younger age, tissues have high healing capacity.…”

“…[7][8][9][10] In case the diagnosis of perforation is made within 24 hours, the treatment of choice is primary closure of the perforation site and wide drainage of the mediastinum. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis.…”

Síndrome de Boerhaave: relato de caso

“…Quando a perfuração esofágica é diagnosticada precocemente (menos de 12 horas), o fechamento primá-rio da lesão com ampla drenagem torácica e mediastinal continua sendo o tratamento preferencial [2][3][4] . A conduta nos casos de diagnóstico tardio é controverso [2][3][4] .…”

“…A conduta nos casos de diagnóstico tardio é controverso [2][3][4] . O fechamento primário da lesão com ou sem reforço é o tratamento mais adequado, sendo o modo mais simples, porém, trazendo maiores índices de falha terapêutica e mortalidade, pois as condições locais e do pró-prio esôfago não são propícias à cicatrização, ocorrendo, na maioria das vezes, deiscência da sutura e piora do quadro de mediastinite que levar ao óbito.…”