The Role of Operation in the Treatment of Boerhaave’s Syndrome

Abstract

Purpose This study aims to discuss the appropriate treatment strategy for spontaneous esophageal rupture. Methods Clinical data from twenty-one cases were retrospectively analyzed. The parameters included etiology, time interval between onset and treatment, therapy methods, prognosis, and length of stay. Results The ratio of males/females was 17/4, age range was 32–82 years (mean = 43.1), and the time interval between onset and treatment was as follows: <24 h: nine cases (42.8%); 24–48 h: six cases (28.6%); and >72 h: six cases (28.6%). All patients underwent operative treatment, and the following primary healing rates were achieved: <24 h: 88.9%, 24–48 h: 66.7%, and >72 h: 0. No patients died in this study. All patients were discharged with recovery, and the average hospitalization times were 18.1 days (<24 h), 27.8 days (24–48 h), and 51.2 days (>72 h). Conclusions Surgical treatment remains an effective method for treating spontaneous esophageal rupture, and the shorter the time interval between onset and treatment, possibly the better the prognosis.

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

“…BS, to our knowledge, has been demonstrated in various patients, including those with gastrointestinal stenosis, Barrett's oesophagus, ileus, and frequent vomiting during continued chemotherapy or gastroscopy and after general anaesthesia [3]. However, in our case, the patient's esophageal wall tear was unusually secondary to oral magnesium sulfate administration, and second, most unique to our case, his rupture was located in the right wall of the distal oesophagus, which was in disagreement with the most frequent site of perforation reported [5]. To our knowledge, this is the rst published case worldwide demonstrating esophageal rupture located in the right wall after taking magnesium sulfate.…”

“…Spontaneous oesophageal rupture, also known as Boerhaave syndrome (BS), is a life-threatening benign disease of the gastrointestinal tract [3] that typically results from a sudden increase in intraoesophageal pressure such as forceful retching or severe vomiting [4] and most frequently occurs in the left wall of the lower third of the oesophagus, a site that is anatomically vulnerable [5]. BS, to our knowledge, has been demonstrated in various patients, including those with gastrointestinal stenosis, Barrett's oesophagus, ileus, and frequent vomiting during continued chemotherapy or gastroscopy and after general anaesthesia [3].…”

“…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].…”

Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

“…Although there is as of yet no de nitive treatment approach, according to current retrospective analysis and clinical experiences, application of operative intervention to repair breakage primarily is considered as priority in current management of Boerhaave's syndrome, especially in the condition as we reported that the patient had presented signs of contamination of the pleural cavity and mediastinum [6].…”

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

“…Currently, BS and more generally esophageal perforations are considered as catastrophic conditions, often life-threatening, with 10 to 40% mortality rates (even higher rates are reported in septic patients with spontaneous perforations) [2]. Due to its very low incidence and aspecific features, more than 50% of cases are misdiagnosed, with a subsequent delay in treatment [3,4].…”