Current approach for Boerhaaves syndrome: A systematic review of case reports

BACKGROUND

There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches. We conducted a systematic review of case reports documenting Boerhaave syndrome.

AIM

To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.

METHODS

We searched PubMed, Google scholar, MEDLINE, and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.

RESULTS

Of the included studies, 49 were case reports, including a total of 56 cases. The mean age was 55.8 ± 16 years old. Initial conservative treatment was performed in 25 cases, while operation was performed in 31 cases. The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission (9.7% vs 44.0%; P = 0.005). Seventeen out of 25 conservative cases (68.0%) were initially treated endoscopic esophageal stenting; 2 of those 17 cases subsequently underwent operation due to poor infection control. Twelve cases developed postoperative leakage (38.7%), and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage. The length of the hospital stay was not significantly different between the conservative treatment and operation cases (operation vs conservation: 33.52 ± 22.69 vs 38.81 ± 35.28 days; P = 0.553).

CONCLUSION

In the treatment of Boerhaave syndrome, it is most important to diagnose the issue immediately. Primary repair with reinforcement is the gold-standard procedure. The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.

Liver function alterations among workers in the shoe industry due to combined low-level exposure to organic solvents

This study aimed to investigate the potential hepatotoxicity, nephrotoxic, and hematotoxic effects of simultaneous occupational low-level exposure of shoe workers to a mixture of organic solvents. The study included 16 male and 55 female workers and non-exposed subjects (n = 60) in the control group. Along with a standard sets of hematological, liver enzymes (aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT), bilirubin total, bilirubin direct, blood glucose, urea, and creatinine were analyzed in all participants. Indoor air quality was monitored using a Gasmet Dx - 4000 multi-component analyzer. Despite the concentration levels of individual chemicals in shoe production units were below the permissible limits, the equivalent exposure (Em) values calculated based on the American Conference of Governmental Industrial Hygienists (ACGIH) and National Institute of Occupational Safety and Health (NIOSH) occupational exposure limits were higher than 1. Statistically significant increase of biochemical parameters (aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), total bilirubin, and direct bilirubin) was obtained in exposed workers of both genders compared with controls (p < 0.001). Calculated liver damage risk scores were significantly higher in both females and males compared with controls (p < 0.001). The multivariate logistic regression analysis showed that direct bilirubin was the most important predictor of organic solvent mixture exposure in the studied group of workers. These results suggest that combined exposure to organic solvents even at low concentrations may lead to hepatotoxicity.

Kambo Frog Poison as a Cause of Esophageal Rupture

The authors present a case of a patient who used Kambo frog poison for body cleansing that induced severe vomiting and led to esophageal rupture followed by tension pneumothorax and septic shock. Kambo is the waxy substance secreted by the nocturnal giant tree frog Phyllomedusa bicolor. Kambo, which is poisonous, is commonly believed in South America to have cleansing and healing properties. As alternative medicine becomes more common, and as more tourists frequent our hospitals, knowledge of these types of ritual related exposures is important for the practicing emergency physician to be aware of.