Tension hydropneumothorax as the initial presentation of Boerhaave syndrome

Lieu, M.B.A. David; Layoun, Michael; Dai, David; Hoo, Guy W. Soo; Betancourt, Jaime

doi:10.1016/j.rmcr.2018.07.007

Cited by 14 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In summary, we present an unusual case of esophageal perforation in a critically ill patient and highlight the importance of including acute esophageal pathology in the differential for a decompensating host in the ICU. Although tension hydropneumothorax has been previously reported as a rare complication of esophageal perforation due to Boerhaave syndrome, these entities have not been previously described in relation to septic shock [ 10 ]. Our review of the literature suggests that intervention within the first 24 hours leads to improved survival.…”

Section: Discussionmentioning

confidence: 99%

Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock

2021

View full text Add to dashboard Cite

Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shockEsophageal perforations occur traumatically or spontaneously and are typically associated with high mortality rates. Early recognition and prompt management are essential. We present the case of a 76-year-old man who was admitted to the medical intensive care unit with fulminant Clostridium difficile colitis, shock, and multi-organ failure. After an initial period of improvement, his condition rapidly deteriorated despite aggressive medical management, and he required mechanical ventilation. Radiography after endotracheal intubation showed interval development of pneumomediastinum and bilateral hydropneumothorax with tension physiology. Chest tube placement resulted in the drainage of multiple liters of dark fluid, and pleural fluid analysis was notable for polymicrobial empyemas. Despite the unusual presentation, esophageal perforation was suspected. Endoscopy ultimately confirmed circumferential separation of the distal esophagus from the stomach, and bedside endoscopic stenting was performed with transient improvement. Two weeks after admission, he developed mediastinitis complicated by recurrent respiratory failure and passed away. This report further characterizes our patient's unique presentation and briefly highlights the clinical manifestations, management options, and outcomes of esophageal perforations.

show abstract

Section: Discussionmentioning

confidence: 99%

Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock

2021

View full text Add to dashboard Cite

show abstract

“…To our knowledge, this is the rst published case worldwide demonstrating esophageal rupture located in the right wall after taking magnesium sulfate. A study revealed that the incidence of spontaneous oesophageal perforation was 3.1/1,000,000 per year, which is an extremely rare entity [6], and the common presentations of BS, including chest or epigastric pain, vomiting, dyspnea and shock, are vulnerable to misdiagnosis as other entities, such as entities cardiogenic in origin, gastrointestinal perforation, acute pancreatitis and abdominal aortic aneurysms [7]. Due to the low incidence rate and high misdiagnosis rate of BS, the diagnosis and therapy of BS are often delayed, resulting in a high mortality and signi cant complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, images including plain chest roentgenograms, oesophagograms, and CT scans also contribute to diagnosing BS [8]. Previous studies have shown that the oesophagogram is a feasible and effective examination for diagnosing oesophageal perforation [5]; however, due to the high false-negative rate of the oesophagogram (15-25%) and tenuous nature of oesophageal rupture, chest CT is considered a more appropriate modality [5,7]. The typical ndings of chest radiography and CT are subcutaneous emphysema, pneumomediastinum, pleural effusion, pneumothorax, and so on [9].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Oesophageal Rupture of The Right Wall After Oral Administration of Sulfate Solution: An Unusual Case Report

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Patients with gastrointestinal stenosis, Barrett's oesophagus, and vomiting during endoscopic preconditioning or after general anaesthesia may develop spontaneous oesophageal rupture in the literature. However, we found an unusual case in which oral sulfate solution triggered oesophageal perforation. Additionally, the oesophageal chasm uncommonly presented at the right wall, while most ruptures are located in the left wall of the oesophagus, and the unexplained and rapidly progressive right-sided pleural effusion in this patient could be associated with this entity. To the best of our knowledge, this is the first published case of oesophageal rupture of the right wall after oral administration of sulfate solution in the literature.Case presentation: For this patient, he suffered from acute onset of unbearable epigastric pain and compression pain in the right chest, with dyspnea, chest tightness and palpitation, after severe nausea and vomiting following oral administration of sulfate solution, and findings from imaging and gastroscopy eventually confirmed oesophageal rupture. Anti-infective treatments, pleural drainage, rehydration and total parenteral nutrition were administered immediately; subsequently, we used a total of seven titanium clips to close the oesophageal rupture under gastroscopic guidance. Eventually, he demonstrated good evolution after the operation and was discharged after recovery. Conclusions: This case emphasizes the importance of considering BS when dealing with patients with severe vomiting, acute chest pain, or dyspnea, especially after administration of sulfate solution for bowel cleansing.

show abstract

“…It is an uncommon condition frequently associated with severe retching and vomiting often associated with alcoholism ; it has an estimated incidence of 3.1 per 1,000,000 per year [5]. It is usually recognized immediately it occurs, presenting with the typical Mackler's triad of chest pain, vomiting and subcutaneous emphysema [6][7][8][9]. However, in few cases, this triad may not be complete, or may be missed and thus present late with complications [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Complicated Boerhaave’s Syndrome Managed by Conservative Treatment

Peter

Shitta

Njem

et al. 2020

JAMMR

View full text Add to dashboard Cite

Boerhaave’s syndrome is a full-thickness perforation of oesophagus associated with vomiting and/or severe straining. It is a severe condition with high morbidity and mortality; the outcome is dependent on early recognition, prompt and effective intervention. It commonly presents early with mediastinitis or pleural effusion. Though uncommon, it can present late with severe chest complications which are usually managed aggressively. The present study reports a 41-year old Nigerian man with Boerhaave’s syndrome who presented with left pneumohydrothorax who was successfully managed with chest tube thoracostomy drainage and parenteral nutrition.

show abstract

Tension hydropneumothorax as the initial presentation of Boerhaave syndrome

Cited by 14 publications

References 18 publications

Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock

Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock

Spontaneous Oesophageal Rupture of The Right Wall After Oral Administration of Sulfate Solution: An Unusual Case Report

Complicated Boerhaave’s Syndrome Managed by Conservative Treatment

Contact Info

Product

Resources

About