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Triantafyllou T, Lamb P, Skipworth R, Couper G, Deans C. Surgical treatment of Boerhaave syndrome in the past, present and future: updated results of a specialised surgical unit. Ann R Coll Surg Engl 2024. [PMID: 38563067 DOI: 10.1308/rcsann.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Boerhaave syndrome is a rare clinical entity associated with high rates of morbidity and mortality. Early recognition of the symptoms, and identification of the site and extension of the injury are key in improving the prognosis. METHODS This study presents data on the mortality, morbidity and length of hospital stay in patients diagnosed with Boerhaave syndrome. The data were retrieved from a prospectively collected database in a single surgical unit between 2012 and 2022. The study makes a comparison with the surgical outcomes of the previous decade. RESULTS Some 33 patients were diagnosed with Boerhaave syndrome and were treated surgically between 2012 and 2022 in a specialist upper gastrointestinal surgical unit. All patients underwent standard surgical repair (in-theatre diagnostic endoscopy, T-tube placement through thoracotomy and feeding jejunostomy through laparotomy). The mean size of the defects in the oesophageal lumen was 3.3cm. Delayed presentation was noted for 13 patients (39%); 8 patients (24%) died in hospital, and 19 patients (58%) developed postoperative complications. Mortality was similar to the rate recorded for the 20 patients from the previous decade (24% vs 20%, respectively). The mean length of hospital stay was 41 days, and was comparable to the 35.7 days reported between 1997 and 2011. CONCLUSIONS Early and aggressive management of spontaneous oesophageal rupture ameliorates the postoperative recovery and prognosis. The surgical results of our unit were found comparable to the previous decade in the population of patients who were treated surgically.
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Affiliation(s)
- T Triantafyllou
- Department of Surgery, Royal Infirmary of Edinburgh, Scotland, NHS Lothian, UK
| | - P Lamb
- Department of Surgery, Royal Infirmary of Edinburgh, Scotland, NHS Lothian, UK
| | - R Skipworth
- Department of Surgery, Royal Infirmary of Edinburgh, Scotland, NHS Lothian, UK
| | - G Couper
- Department of Surgery, Royal Infirmary of Edinburgh, Scotland, NHS Lothian, UK
| | - C Deans
- Department of Surgery, Royal Infirmary of Edinburgh, Scotland, NHS Lothian, UK
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2
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Deng YJ, Liu HP, Zou JB. Unconventional surgery for thoracic esophageal rupture with empyema and mediastinitis: a case report and literature review. J Cardiothorac Surg 2023; 18:190. [PMID: 37312152 DOI: 10.1186/s13019-023-02208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/02/2023] [Indexed: 06/15/2023] Open
Abstract
Treatment of esophageal perforation or rupture is complicated and controversial, especially in advanced cases. In fact, it is generally accepted that this disease must be treated individually according to the location, causes and clinical features of rupture or perforation. A very rare case was admitted to our department, who was injured 5 days ago by high-pressure gas of a running air compressor and resulted in a long-term longitudinal rupture of the thoracic esophagus. Although the patient suffered from empyema and mediastinitis at the same time, and his condition was very serious, the debridement and desquamation of empyema were still implemented, followed by left thoracic esophagectomy and left neck approach esophagogastrostomy in the same period successfully. The patient got a good result finally.
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Affiliation(s)
- Yong-Jun Deng
- Department of Thoracic Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province, Yunnan Eye Hospital), Kunming, Yunnan Province, 650021, P.R. China.
| | - Huan-Peng Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province, Yunnan Eye Hospital), Kunming, Yunnan Province, 650021, P.R. China
| | - Jian-Bin Zou
- Department of Thoracic Surgery, The Affiliated Hospital of Yunnan University (The Second People's Hospital of Yunnan Province, Yunnan Eye Hospital), Kunming, Yunnan Province, 650021, P.R. China
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3
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Ariza-Traslaviña J, Caballero-Otálora N, Polanía-Sandoval CA, Perez-Rivera CJ, Tellez LJ, Mosquera M. Two-staged surgical management for complicated Boerhaave syndrome with esophagectomy and deferred gastroplasty: A case report. Int J Surg Case Rep 2023; 103:107881. [PMID: 36640469 PMCID: PMC9845990 DOI: 10.1016/j.ijscr.2023.107881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures. PRESENTATION OF CASE A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present. CLINICAL DISCUSSION The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient's outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction. CONCLUSION In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.
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Affiliation(s)
- Julián Ariza-Traslaviña
- Thoracic Surgery Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | | | - Camilo Andrés Polanía-Sandoval
- Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia; General Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Carlos J Perez-Rivera
- General Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
| | - Luis J Tellez
- Thoracic Surgery Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Manuel Mosquera
- General Surgery Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
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Wiggins B, Banno F, Knight KT, Fladie I, Miller J. Boerhaave Syndrome: An Unexpected Complication of Diabetic Ketoacidosis. Cureus 2022; 14:e25279. [PMID: 35755500 PMCID: PMC9224768 DOI: 10.7759/cureus.25279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 12/01/2022] Open
Abstract
Boerhaave syndrome (BS) is a rare gastrointestinal condition related to esophageal rupture that carries a high mortality rate without prompt medical attention. BS is commonly associated with repeated episodes of severe retching, straining, or vomiting. Diabetic ketoacidosis (DKA), a serious acute complication of diabetes, is characterized in part by laboratory findings of profound hyperglycemia and ketoacidosis. Clinically, nausea and vomiting are seen commonly in DKA patients, which can often include repeated forceful retching, but rarely associated with esophageal rupture. In this article, we will describe a case of BS secondary to repeated episodes of emesis in the setting of DKA.
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Willems S, Daemen JHT, Hulsewé KWE, Belgers EHJ, Sosef MN, Soufidi K, Vissers YLJ, de Loos ER. Outcomes after hybrid minimally invasive treatment of Boerhaave syndrome: a single-institution experience. Acta Chir Belg 2022:1-6. [PMID: 35020548 DOI: 10.1080/00015458.2022.2029035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Spontaneous esophageal perforation or Boerhaave syndrome is a life-threatening emergency, associated with significant morbidity and mortality. In this retrospective series we describe our single-center experience with a hybrid minimally invasive treatment approach for the treatment of Boerhaave syndrome. METHODS Clinical data of all patients who presented with spontaneous esophageal rupture between January 2009 and December 2019 were analyzed. All patients underwent esophageal endoscopic stenting to seal the perforation and debridement of the contaminated mediastinal and pleural cavity through video-assisted thoracoscopic surgery (VATS). Primary outcome measure was defined as in-hospital death and 30-day mortality. RESULTS Twelve patients were included with a median age of 63 years (interquartile range [IQR] 51-74 years) of whom 58% (n = 7) were male. The median Pittsburg perforation severity score was 6.5 (IQR 6-9). Endoscopic reintervention was required in 8 patients (67%), primarily due to stent dislocation. In addition, 5 patients (42%) required re-VATS due to empyema formation. Thirty-day mortality and in-hospital mortality were respectively 17% (n = 2) and 25% (n = 3). CONCLUSION Endoscopic stenting in combination with thoracoscopic debridement is an effective and safe minimally invasive hybrid approach for the treatment of Boerhaave syndrome. This is depicted by the relatively low mortality rates, even among patients with high perforation severity scores. The relatively low mortality rates may be attributed to the combined approach of rapidly sealing the defect and decontamination of the thorax. Future studies should aim to corroborate this evidence which is limited by its sample size and retrospective nature.
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Affiliation(s)
- Stefanie Willems
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Jean H. T. Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Karel W. E. Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Eric H. J. Belgers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Khalida Soufidi
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Yvonne L. J. Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Erik R. de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
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Yan XL, Jing L, Guo LJ, Huo YK, Zhang YC, Yan XW, Deng YZ. Surgical management of Boerhaave's syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:669-674. [PMID: 32496118 DOI: 10.17235/reed.2020.6746/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND spontaneous esophageal rupture (Boerhaave's syndrome) is a rare and challenging clinical condition. OBJECTIVE to evaluate the outcome of different surgical treatments for patients with Boerhaave's syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. PATIENTS AND METHODS eighty-eight patients with Boerhaave's syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). RESULTS the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). CONCLUSIONS it is very important to establish an early diagnosis for patients with Boerhaave's syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
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Affiliation(s)
- Xiao-Liang Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University, china
| | - Li Jing
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Lin-Jing Guo
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yun-Kui Huo
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Cai Zhang
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Xiu-Wen Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Zhi Deng
- Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University,
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7
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Aref H, Yunus T, Alhallaq O. Laparoscopic Management of Boerhaave's syndrome: a case report with an intraoperative video. BMC Surg 2019; 19:109. [PMID: 31409335 PMCID: PMC6693239 DOI: 10.1186/s12893-019-0576-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
Background Boerhaave’s syndrome involves a sudden elevation in the intraluminal pressure of the esophagus, causing a transmural perforation. It is associated with high morbidity and mortality. Its treatment is challenging, and early surgical intervention is the most crucial prognostic element. Case presentation We present a case of a 32 year-old male who presented after severe emesis with an acute onset of epigastric pain. He was diagnosed with Boerhaave’s syndrome. Displaying signs of shock mandated immediate surgical exploration with laparoscopic primary repair. Conclusion The golden period of the first 24 hrs of the event still applies to cases of esophageal perforation. The scarcity of these cases makes a comparison between the various treatment methods difficult. Our data support the use of laparoscopic intervention with primary repair as the mainstay of treatment for the management of esophageal perforation. Electronic supplementary material The online version of this article (10.1186/s12893-019-0576-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hager Aref
- Department of Surgery, International Medical Center, P.O. Box 2172, Jeddah, 21451, Saudi Arabia.
| | - Tahir Yunus
- Department of Surgery, International Medical Center, P.O. Box 2172, Jeddah, 21451, Saudi Arabia
| | - Obadah Alhallaq
- Department of Surgery, International Medical Center, P.O. Box 2172, Jeddah, 21451, Saudi Arabia
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8
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Abstract
Well-timed diagnostics of a spontaneous nontraumatic rupture of esophagus or Boerhaave’s syndrome, presents great difficulties because of his rarity and a variety of clinical implications. Esophagus ruptures may feign various organs pathology [2] that most often demands differential diagnostics with a stomach ulcer perforation, acute myocardial infarction, pulmonary artery embolism, aortic dissection and pancreatitis [16, 17]. The treatment can include conservative and surgical tools, but still accompanied by high mortality (up to 35%) [7]; results largely defined by the time between the moment of a rupture and start of the treatment. In addition to the review, described the experience of successful treatment of a patient with Boerhaave’s syndrome in the light of the generalized today data of world medical literature on this problem.
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9
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Awais M, Qamar S, Rehman A, Baloch NUA, Shafqat G. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Eur J Trauma Emerg Surg 2018; 45:517-525. [PMID: 29484462 DOI: 10.1007/s00068-018-0929-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients. METHODS We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard. RESULTS Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29-53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases. CONCLUSION Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan. .,Department of Radiology, Dow University of Health Sciences, Ojha Campus, Suparco Road, KDA Scheme 33, Karachi, Sindh, 75270, Pakistan.
| | - Saqib Qamar
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Abdul Rehman
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. box 3050, Doha, Qatar
| | - Noor Ul-Ain Baloch
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Gulnaz Shafqat
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
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Cui Y, Ren Y, Shan Y, Chen R, Wang F, Zhu Y, Zhang Y. Pediatric esophagopleural fistula: Two case reports and a literature review. Medicine (Baltimore) 2017; 96:e6695. [PMID: 28489746 PMCID: PMC5428580 DOI: 10.1097/md.0000000000006695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Esophagopleural fistula (EPF) is rarely reported in children with a high misdiagnosis rate. This study aimed to reveal the clinical manifestations and managements of EPF in children.Two pediatric cases of EPF in our hospital were reported. A bibliographic search was performed on the PubMed, WANFANG, and CNKI databases for EPF-related reports published between January 1980 and May 2016. The pathogeny, clinical manifestations, diagnosis, treatments, and prognosis of EPF patients were collected and discussed.Based on conservative treatments, 1 pediatric EPF case induced by cervical trauma was cured by longitudinal septum incision-mediated drainage. The other pediatric EPF induced by endoscopic balloon dilation was cured by dual stent implantation. A total of 38 studies of 197 EPF patients (191 adults and 6 children) were reviewed. Latrogenic factor, esophageal foreign body, and infection are considered the main causes of EPF in children. Unilateral pleural effusion accompanied by food residue was the main manifestations of EPF. Chest computed tomography (CT) and contrast esophagography were usually used in the diagnosis of EPF with high accuracy. Surgical treatment in adults with EPF exhibited a significantly higher cure rate and lower mortality rate than conservative treatment (P < .01).Pleural effusion with food residue is a specific finding in EPF. Chest CT exhibited high sensitivity for the diagnosis of EPF. Conservative treatment may be preferable for pediatric patients with EPF.
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11
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Mirus M, Heller AR. [Diagnostic investigation in emergency medicine: Why case history is crucial]. Anaesthesist 2017; 66:256-264. [PMID: 28194478 DOI: 10.1007/s00101-017-0280-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/09/2016] [Accepted: 01/26/2017] [Indexed: 11/29/2022]
Abstract
We present the preclinical case of a patient reporting chest pain. Pain impeded physical examination. Reviewing the patient's detailed medical history after analgesia revealed a connection between the reported pain and vomiting. This led to a suspicion of organ perforation. Thus, the patient was admitted to a surgical emergency room (ER) and Boerhaave's Syndrome was diagnosed. After deterioration in the ER, cardiopulmonal reanimation (CPR), and successful surgical treatment, the patient was transferred to the intensive care unit (ICU) seven hours after first contact.
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Affiliation(s)
- M Mirus
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | - A R Heller
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland
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12
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Cayci HM, Erdoğdu UE, Dilektasli E, Turkoglu MA, Firat D, Cantay H. An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery. J Minim Access Surg 2017; 13:69-72. [PMID: 27251836 PMCID: PMC5206845 DOI: 10.4103/0972-9941.181760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.
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Affiliation(s)
- Haci Murat Cayci
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Umut Eren Erdoğdu
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Evren Dilektasli
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Akif Turkoglu
- Department of General Surgery, Antalya University Medical School, Antalya, Turkey
| | - Deniz Firat
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hasan Cantay
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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13
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Esophageal Rupture After Ghost Pepper Ingestion. J Emerg Med 2016; 51:e141-e143. [DOI: 10.1016/j.jemermed.2016.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/06/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
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14
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Gupta A, Mody P, Bhushan S. An unusual cause of shortness of breath. Intern Emerg Med 2016; 11:1025-6. [PMID: 26715452 DOI: 10.1007/s11739-015-1373-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Arjun Gupta
- Department of Internal Medicine, University of Texas Southwestern Medical Centre, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA.
| | - Purav Mody
- Department of Internal Medicine, University of Texas Southwestern Medical Centre, 5323 Harry Hines Blvd, Dallas, TX, 75390-9047, USA
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15
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King WD, Dickinson MC. Oesophageal injury. BJA Educ 2015. [DOI: 10.1093/bjaed/mku039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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17
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Troja A, Käse P, El-Sourani N, Miftode S, Raab HR, Antolovic D. Treatment of Esophageal Perforation: A Single-Center Expertise. Scand J Surg 2014; 104:191-5. [DOI: 10.1177/1457496914546435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/14/2014] [Indexed: 11/15/2022]
Abstract
Background and Aims: Esophageal perforation is a rare diagnosis, which is associated with a high morbidity and mortality. There is only small scientific background regarding the best choice of treatment. Parameters indicating a good clinical outcome seem to be localization, depth of the defect, pre-existing risk factors, and time interval between the event and start of treatment. Material and Methods: We evaluate retrospective data from 39 patients who were treated with a esophageal perforation in our hospital between 2004 and 2012. Results and Conclusions: Our collected data agree with the available published literature. Endoscopic treatment seems to be favorable in early diagnosis.
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Affiliation(s)
- A. Troja
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - P. Käse
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - N. El-Sourani
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - S. Miftode
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - H. R. Raab
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
| | - D. Antolovic
- Department for General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany
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18
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Connelly CL, Lamb PJ, Paterson-Brown S. Outcomes following Boerhaave's syndrome. Ann R Coll Surg Engl 2013; 95:557-60. [PMID: 24165336 PMCID: PMC4311529 DOI: 10.1308/rcsann.2013.95.8.557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Boerhaave's syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. METHODS Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. RESULTS Twenty patients with Boerhaave's syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. CONCLUSIONS Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave's syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.
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Affiliation(s)
- C L Connelly
- The Royal Infirmary of Edinburgh, 72/3 Marchmont Road, Edinburgh EH9 1HS, UK.
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19
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Abstract
This article outlines infections in the submandibular, lateral pharyngeal, retropharyngeal, danger, and prevertebral spaces, in conjunction with infections of the sinuses and mediastinum. By understanding the anatomy and pathophysiology, the reader will gain insight into the rationale for various therapeutic options.
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Affiliation(s)
- Denise Jaworsky
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
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20
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Tonolini M, Bianco R. Spontaneous esophageal perforation (Boerhaave syndrome): Diagnosis with CT-esophagography. J Emerg Trauma Shock 2013; 6:58-60. [PMID: 23493470 PMCID: PMC3589863 DOI: 10.4103/0974-2700.106329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 07/27/2012] [Indexed: 11/04/2022] Open
Abstract
Spontaneous esophageal perforation (Boerhaave syndrome) is a very uncommon, life-threatening surgical emergency that should be suspected in all patients presenting with lower thoracic-epigastric pain and a combination of gastrointestinal and respiratory symptoms. Variable clinical manifestations and subtle or unspecific radiographic findings often result in critical diagnostic delays. Multidetector computed tomography complemented with CT-esophagography represents the ideal "one-stop shop" investigation technique to allow a rapid, comprehensive diagnosis of BS, including identification of suggestive periesophageal abnormalities, direct visualization of esophageal perforation and quantification of mediastinitis.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157 Milan, Italy
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21
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Abstract
A 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.
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Affiliation(s)
- Sarah White
- Department of Geriatric Medicine, Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK.
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22
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Haveman JW, Nieuwenhuijs VB, Kobold JPM, van Dam GM, Plukker JT, Hofker HS. Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave's syndrome. Surg Endosc 2011; 25:2492-7. [PMID: 21359901 PMCID: PMC3142333 DOI: 10.1007/s00464-011-1571-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/31/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Boerhaave's syndrome has a high mortality rate (14-40%). Surgical treatment varies from a minimal approach consisting of adequate debridement with drainage of the mediastinum and pleural cavity to esophageal resection. This study compared the results between a previously preferred open minimal approach and a video-assisted thoracoscopic surgery (VATS) procedure currently considered the method of choice. METHODS In this study, 12 consecutive patients treated with a historical nonresectional drainage approach (1985-2001) were compared with 12 consecutive patients treated prospectively after the introduction of VATS during the period 2002-2009. Baseline characteristics were equally distributed between the two groups. RESULTS In the prospective group, 2 of the 12 patients had the VATS procedure converted to an open thoracotomy, and 2 additional patients were treated by open surgery. In the prospective group, 8 patients experienced postoperative complications compared with all 12 patients in the historical control group. Four patients (17%), two in each group, underwent reoperation. Six patients, three in each group, were readmitted to the hospital. The overall in-hospital mortality was 8% (1 patient in each group), which compares favorably with other reports (7-27%) based on drainage alone. CONCLUSIONS Adequate surgical debridement with drainage of the mediastinum and pleural cavity resulted in a low mortality rate. The results for VATS in this relatively small series were comparable with those for an open thoracotomy.
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Affiliation(s)
- Jan Willem Haveman
- Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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Vallböhmer D, Hölscher AH, Hölscher M, Bludau M, Gutschow C, Stippel D, Bollschweiler E, Schröder W. Options in the management of esophageal perforation: analysis over a 12-year period. Dis Esophagus 2010; 23:185-90. [PMID: 19863642 DOI: 10.1111/j.1442-2050.2009.01017.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Controversies exist about the management of esophageal perforation in order to eliminate the septic focus. The aim of this study was to assess the etiology, management, and outcome of esophageal perforation over a 12-year period, in order to characterize optimal treatment options in this severe disease. Between May 1996 and May 2008, 44 patients (30 men, 14 women; median age 67 years) with esophageal perforation were treated in our department. Etiology, diagnostic procedures, time interval between clinical presentation and treatment, therapeutic management, and outcome were analyzed retro- or prospectively for each patient. Iatrogenic injury was the most frequent cause of esophageal perforation (n= 28), followed by spontaneous (n= 9) and traumatic (n= 4) esophageal rupture (in three patients, the reasons were not determinable). Eight patients (18%) underwent conservative treatment with cessation of oral intake, antibiotics, and parenteral nutrition. Twelve (27%) patients received an endoscopic stent implantation. Surgical therapy was performed in 24 (55%) patients with suturing of the lesion in nine patients, esophagectomy with delayed reconstruction in 14 patients, and resection of the distal esophagus and gastrectomy in one patient. In case of iatrogenic perforation, conservative or interventional therapy was performed each in 50% of the patients; 89% of the patients with a Boerhaave syndrome underwent surgery. The hospital mortality rate was 6.8% (3 of 44 patients): one patient with an iatrogenic perforation after conservative treatment, and two patients after surgery (one with Boerhaave syndrome, one with iatrogenic rupture). No death occurred in the 25 patients with a diagnostic interval less than 24 hours, whereas the mortality rate in the group (n= 16 patients) with a diagnostic interval of more than 24 hours was 19% (P= 0.053). In three patients, the diagnostic interval was not determinable retrospectively. An individualized therapy depending on etiology, diagnostic delay, and septic status leads to a low mortality of esophageal perforation.
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Affiliation(s)
- D Vallböhmer
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
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24
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Cannon M. An 82-year-old Man With A 2-Day History of Vomiting and Epigastric Pain. J Emerg Nurs 2010; 36:36-7. [DOI: 10.1016/j.jen.2009.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 11/28/2022]
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Hung JJ. Spontaneous rupture of the oesophagus (Br J Surg 2008; 95: 1115-1120). Br J Surg 2009; 96:951; author reply 951-2. [PMID: 19591155 DOI: 10.1002/bjs.6757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Sutcliffe RP, Forshaw MJ, Datta G, Rohatgi A, Strauss DC, Mason RC, Botha AJ. Surgical management of Boerhaave's syndrome in a tertiary oesophagogastric centre. Ann R Coll Surg Engl 2009; 91:374-80. [PMID: 19409144 DOI: 10.1308/003588409x428298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The aim of this study was to review the management and outcome of patients with Boerhaave's syndrome in a specialist centre between 2000-2007. PATIENTS AND METHODS Patients were grouped according to time from symptoms to referral (early, < 24 h; late, > 24 h). The effects of referral time and management on outcomes (oesophageal leak, reoperation and mortality) were evaluated. RESULTS Of 21 patients (early 10; late 11), three were unfit for surgery. Of the remaining 18, immediate surgery was performed in 8/8 referred early and 6/10 referred late. Four patients referred late were treated conservatively. Oesophageal leak (78% versus 12.5%; P < 0.05) and mortality (40% versus 0%; P < 0.05) rates were higher in patients referred late. For patients referred late, mortality was higher in patients managed conservatively (75% versus 17%; not significant). CONCLUSIONS The best outcomes in Boerhaave's syndrome are associated with early referral and surgical management in a specialist centre. Surgery appears to be superior to conservative treatment for patients referred late.
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Spontaneous perforation of cervical oesophagus: a rare variant of Boerhaave's syndrome. The Journal of Laryngology & Otology 2009; 123:1378-80. [DOI: 10.1017/s0022215109004952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting.Investigations:Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis.Diagnosis:Contained oesophageal perforation.Management:Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.
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Rohatgi A, Papanikitas J, Sutcliffe R, Forshaw M, Mason R. The role of oesophageal diversion and exclusion in the management of oesophageal perforations. Int J Surg 2009; 7:142-4. [DOI: 10.1016/j.ijsu.2008.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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Wang Y, Zhang R, Zhou Y, Li X, Cheng Q, Wang Y, Liu K, Wang X. Our experience on management of Boerhaave's syndrome with late presentation. Dis Esophagus 2008; 22:62-7. [PMID: 18847455 DOI: 10.1111/j.1442-2050.2008.00858.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- Y Wang
- Department of Thoracic Surgery, Tangdu Hospital, Forth Military Medical University, Xi'an, China.
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Griffin SM, Lamb PJ, Shenfine J, Richardson DL, Karat D, Hayes N. Spontaneous rupture of the oesophagus. Br J Surg 2008; 95:1115-20. [PMID: 18655213 DOI: 10.1002/bjs.6294] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. METHODS Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a non-operative approach, whereas the remainder underwent thoracotomy. RESULTS The median time to diagnosis was 24 (range 4-604) h. Initial diagnosis was by contrast swallow in 18 of 24 patients, computed tomography in 15 of 17 and endoscopy in 18 of 18. There were no deaths among 17 patients who were managed non-operatively with targeted drainage, intravenous antimicrobials, nasogastric decompression and enteral nutrition. Of 31 patients who underwent primary thoracotomy and oesophageal repair (over a Ttube in 29), 11 died in hospital. Three patients could not be resuscitated adequately and did not have surgical intervention. CONCLUSION Spontaneous oesophageal rupture represents a spectrum of disease. Accurate radiological and endoscopic evaluation can identify those suitable for radical non-operative treatment and those who require thoracotomy.
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Affiliation(s)
- S M Griffin
- Department of Upper Gastrointestinal Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Medford ARL, Maskell NA. An oesophageal stent and a milky effusion. Palliat Med 2007; 21:653-4. [PMID: 17942507 DOI: 10.1177/0269216307081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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