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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gao RY, Wei XL, Wu JF, Zhou ZW, Yu XQ. The perilous consequences of bowel preparation: a case study with literature review of Boerhaave syndrome. Front Med (Lausanne) 2024; 11:1303305. [PMID: 38529122 PMCID: PMC10961334 DOI: 10.3389/fmed.2024.1303305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/26/2024] [Indexed: 03/27/2024] Open
Abstract
Colonoscopy is widely acknowledged as a prevalent and efficacious approach for the diagnosis and treatment of gastrointestinal disorders. In order to guarantee an effective colonoscopy, it is imperative for patients to undergo an optimal bowel preparation regimen. This entails the consumption of a substantial volume of a non-absorbable solution to comprehensively purge the colon of any fecal residue. Nevertheless, it is noteworthy to acknowledge that the bowel preparation procedure may occasionally elicit adverse symptoms such as nausea and vomiting. In exceptional instances, the occurrence of excessive vomiting may lead to the rupture of the distal esophagus, a grave medical condition referred to as Boerhaave syndrome (BS). Timely identification and efficient intervention are imperative for the management of this infrequent yet potentially perilous ailment. This investigation presents a case study of a patient who developed BS subsequent to the ingestion of mannitol during bowel preparation. Furthermore, an exhaustive examination of extant case reports and pertinent literature on esophageal perforation linked to colonoscopy has been conducted. This analysis provides valuable insights into the prevention, reduction, and treatment of such serious complications.
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Affiliation(s)
| | | | | | | | - Xi-qiu Yu
- Department of Gastroenterology, Shenzhen Luohu People’s Hospital, Shenzhen, China
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3
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Anundsen TK, Førland DT, Johannessen HO, Johnson E. Outcome after stent and endoscopic vacuum therapy-based treatment for postemetic esophageal rupture. Scand J Gastroenterol 2024; 59:1-6. [PMID: 37592384 DOI: 10.1080/00365521.2023.2248537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Extent of surgical repair of spontaneous esophageal effort rupture (Boerhaave syndrome) has gradually decreased by the emergence of minimal invasive treatment based on endoscopic stent sealing of the perforation. However, for this diagnosis, use of endoscopic vacuum therapy (EVT) is still in its beginning. We present our results after 7-years with both stent and/or EVT-based treatment. MATERIALS AND METHODS 17 consecutive patients with Boerhaave syndrome from June 2015 to May 2022 were retrospectively registered in a database. The perforation was sealed by stent and/or EVT, and gastric effluent was drained transthoracically by a chest tube or pigtail catheter. Eight out of 14 patients responded to questions on fatigue and dysphagia (Ogilvie's score). RESULTS Seventeen patients aged median 67 years (range 34-88), had a primary hospital stay of 38 days (7-68). Ninety-day mortality was 6% (n = 1). Perforations were sealed with stent (n = 10), EVT (n = 3) or stent and EVT (n = 4). One patient (6%) needed laparoscopic lavage and transhiatal drainage. Eight patients (47%) were re-stented due to persistent leakage (n = 4) and stent migration (n = 4). Fifteen patients (88%) had complications, including multi-organ failure (n = 9), pleural empyema (n = 8) and esophageal stricture (n = 3). The perforations healed. After 35.5 months (range 2-62) fourteen patients were alive. Eight that responded had no dysphagia and total fatigue score comparable to an age-matched reference population. CONCLUSION Mortality rate was low after initial stent and EVT-based treatment of Boerhaave syndrome, combined with adequate transthoracic drainage of gastric effluent. Patients required repeated minimal invasive procedures, but with no apparent negative effect on functional outcome.
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Affiliation(s)
- Tommy Kallåk Anundsen
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dag Tidemann Førland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Hans-Olaf Johannessen
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Egil Johnson
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Estorninho J, Pimentel R, Gravito-Soares M, Gravito-Soares E, Amaro P, Figueiredo P. Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip. GE Port J Gastroenterol 2023; 30:444-450. [PMID: 38476151 PMCID: PMC10928871 DOI: 10.1159/000527317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/30/2022] [Indexed: 03/14/2024]
Abstract
Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.
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Affiliation(s)
- João Estorninho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Pimentel
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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5
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Piratheepan A, Inthujan S, Sutharshan V. Successful retrosternal esophageal bypass with gastric transposition in the management of esophago-pleural fistula as a complication of Boerhaave syndrome. Int J Surg Case Rep 2023; 111:108797. [PMID: 37722308 PMCID: PMC10514066 DOI: 10.1016/j.ijscr.2023.108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Boerhaave syndrome is a rare life-threatening condition that represents about 15 % of esophageal perforation and is associated with significant mortality. A subset of patients with effort rupture of the esophagus can present with esophago-pleural fistula. Management of esophago-pleural fistula remains a challenge due to the lack of high-quality evidence studies and the rarity of reported cases. Esophageal bypass with gastric transposition could have a role in management by using the same principles used in chronic esophago-pleural fistula in esophageal malignancy. CASE PRESENTATION We report a unique case of a 33-year-old male with effort rupture of esophagus who developed esophago-pleural fistula successfully managed with an esophageal bypass with gastric transposition after multiple attempts of CSES placement have failed. CLINICAL DISCUSSION Boerhaave syndrome is a rare clinical presentation with mortality ranging from 20 to 50 %. A case of Boerhaave syndrome present with esophageal pleural fistula is uncommon despite the anatomical proximity of these structures. For delayed presentation deployment of CSES to control the fistula was not effective as retrosternal esophageal bypass in this case study. CONCLUSIONS Esophageal bypass with gastric transposition might be an effective strategy for esophago-pleural fistula compared to CSES placement following delayed presentation of Boerhaave syndrome but further appropriately designed studies are required to make recommendations.
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Affiliation(s)
- A Piratheepan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka.
| | - S Inthujan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka
| | - V Sutharshan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka
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Tarazona MAD, Chaves CER, Mateus JFI, Comba FAR, Rosso JD, Uribe MCA. Boerhaave syndrome: Successful conservative treatment. Case report and literature review. Int J Surg Case Rep 2023; 107:108289. [PMID: 37187116 DOI: 10.1016/j.ijscr.2023.108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spontaneous esophageal perforation or "Boerhaave" syndrome is an uncommon pathology, with high rates of morbidity and mortality. Clinical scores such as the Pittsburgh classification could guide the treatment and helps to assess mortality risk. Conservative management could be performed in selected cases. CASE PRESENTATION We present a 19-year-old male patient with a previous history of anxiety and depression, who enters the emergency room with vomiting and epigastric pain followed by swelling at the neck and dysphagia. Neck tomography and chest tomography were obtained showing subcutaneous emphysema. Conservative management was indicated and after 10 days of in-hospital stay and no complications, the patient was discharged. Any complication was observed after 30, 60, and 90 days of follow-up. CLINICAL DISCUSSION Selected patients with Boerhaave syndrome could benefit from conservative management. Risk classification could be performed using the Pittsburgh score. Nil per os, antibiotic treatment, and nutritional support are the cornerstone of nonoperative management. CONCLUSION Boerhaave syndrome it's an infrequent pathology, with mortality rates ranging between 30 and 50 %. Early identification and on-time management are required to have favorable outcomes. Pittsburgh score can be used to guide the selection of patients who benefit from conservative treatment.
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Affiliation(s)
| | - Carlos Eduardo Rey Chaves
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.
| | - Juan Felipe Infante Mateus
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | | | - J D Rosso
- Cirujano General, Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maria Camila Azula Uribe
- Cirujano General, Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
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Yamana I, Fujikawa T, Kawamura Y, Hasegawa S. Current approach for Boerhaaves syndrome: A systematic review of case reports. World J Meta-Anal 2023; 11:112-124. [DOI: 10.13105/wjma.v11.i4.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023] Open
Abstract
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.
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Affiliation(s)
- Ippei Yamana
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Yuichiro Kawamura
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
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8
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Chen YH, Lin PC, Chen YL, Yiang GT, Wu MY. Point-of-Care Ultrasonography Helped to Rapidly Detect Pneumomediastinum in a Vomiting Female. Medicina (Kaunas) 2023; 59. [PMID: 36837595 DOI: 10.3390/medicina59020394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Terui E, Tanaka S, Yotsumoto K, Ohsone Y, Terui K. Hydropneumothorax in a neonate caused by esophageal rupture with duodenal obstruction. Pediatr Int 2023; 65:e15713. [PMID: 38088466 DOI: 10.1111/ped.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Elena Terui
- Department of Pediatric Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Saori Tanaka
- Department of Pediatrics, Chiba Rosai Hospital, Chiba, Japan
| | - Katsumi Yotsumoto
- Department of Pediatric Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Yoshiteru Ohsone
- Department of Pediatrics, Chiba University School of Medicine, Chiba, Japan
| | - Keita Terui
- Division of Pediatric Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Japan
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11
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Debiche S, Snene H, Attia M, Ben Abdelghani K, Ben Salah N, Blibech H, Ben Farhat L, Laater A, Mehiri N, Louzir B. [Pneumomediastinum and vomiting: Which approach to diagnosis? A case report]. Rev Mal Respir 2022; 39:726-730. [PMID: 36064640 DOI: 10.1016/j.rmr.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Spontaneous pneumomediastinum (SPM) is a rare and often unrecognized condition of which vomiting is one of the reported triggering factors. Differentiating SPM from Boerhaave's syndrome (pneumomediastinum secondary to esophageal breach) is the first step in management and prognosis. OBSERVATION A 27-year-old woman with systemic lupus erythematous presented to the emergency department with epigastralgia, incoercible vomiting and diarrhoea. Abdominal CT showed circumferential thickening of the duodenum and bilateral ureteritis. Chest sections showed pneumomediastinum extending to the cervical region. Therapeutic management was based on prophylactic antibiotic therapy and an absolute diet (fasting). A CT scan with upper gastrointestinal opacification was performed to prevent esophageal rupture and showed quasi-obstructive thickening of the antral mucosa. The diagnosis was lupus enteritis and pneumomediastinum was secondary to the vomiting efforts. The patient was placed on corticosteroids and a favorable outcome ensued. CONCLUSION Strenuous vomiting is one of the precipitating factors of SPM. Boerhaave's syndrome is the main differential diagnosis with a poor prognosis, unlike SPM, which has a good prognosis with conservative treatment.
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Affiliation(s)
- S Debiche
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie.
| | - H Snene
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie
| | - M Attia
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de radiologie, Tunis, Tunisie
| | - K Ben Abdelghani
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de rhumatologie, Tunis, Tunisie
| | - N Ben Salah
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie
| | - H Blibech
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie
| | - L Ben Farhat
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de radiologie, Tunis, Tunisie
| | - A Laater
- Université de Tunis El Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de rhumatologie, Tunis, Tunisie
| | - N Mehiri
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie
| | - B Louzir
- Université de Tunis El-Manar, faculté de médecine de Tunis, CHU de Mongi Slim La Marsa, service de pneumologie allergologie, Tunis, Tunisie
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12
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Andreatta E, Lovece A, Milani V, Asti E, Bonavina L. Does the Pittsburgh Severity Score Predict Patients' Outcomes in Benign Esophageal Perforations? J Gastrointest Surg 2022; 26:1757-1759. [PMID: 35229251 DOI: 10.1007/s11605-022-05281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/19/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Erika Andreatta
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrea Lovece
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Valentina Milani
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
- IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
- Department of Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Malan 1, San Donato Milanese (Milano), 20097, Milan, Italy.
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13
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Tuñon C, De Lucas J, Cubilla J, Andrade R, Aguirre M, Zúñiga Cisneros J. Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis. BMC Gastroenterol 2021; 21:484. [PMID: 34930127 PMCID: PMC8685809 DOI: 10.1186/s12876-021-02058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.
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Affiliation(s)
- Carlos Tuñon
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Juan De Lucas
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Jan Cubilla
- Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama
| | - Rafael Andrade
- Department of Thoracic Surgery, Santo Tomas Hospital, Panama City, Panama
| | - Miguel Aguirre
- Department of Thoracic Surgery, Santo Tomas Hospital, Panama City, Panama
| | - Julio Zúñiga Cisneros
- Department of Internal Medicine, Santo Tomas Hospital, Bella Vista, Panama City, Panama.
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14
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DeVivo A, Sheng AY, Koyfman A, Long B. High risk and low prevalence diseases: Esophageal perforation. Am J Emerg Med 2021; 53:29-36. [PMID: 34971919 DOI: 10.1016/j.ajem.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Esophageal perforation is a rare but serious condition associated with a high rate of morbidity and mortality. OBJECTIVE This article highlights the pearls and pitfalls of esophageal perforation, including diagnosis, initial resuscitation, and management in the emergency department based on current evidence. DISCUSSION Esophageal perforation occurs with injury to the layers of the esophagus, resulting in mediastinal contamination and sepsis. While aspects of the history and physical examination may prompt consideration of the diagnosis, the lack of classic signs and symptoms cannot be used to rule out esophageal perforation. Chest radiograph often exhibits indirect findings suggestive of esophageal perforation, but these are rarely diagnostic. Advanced imaging is necessary to make the diagnosis, evaluate the severity of the injury, and guide appropriate management. Management focuses on hemodynamic stabilization with intravenous fluids and vasopressors if needed, gastric decompression, broad-spectrum antibiotics, and a thoughtful approach to airway management. Proton pump inhibitors and antifungals may be used as adjunctive therapies. Current available evidence for various treatment options (conservative, endoscopic, and surgical interventions) for esophageal perforation and resulting patient outcomes are limited. A multidisciplinary team approach with input from thoracic surgery, interventional radiology, gastroenterology, and critical care is recommended, with admission to the intensive care setting. CONCLUSIONS An understanding of esophageal perforation can assist emergency physicians in diagnosing and managing this deadly disease.
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15
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Martínez-García A, Pérez-García K, Pérez-Palenzuela J, Sosa-Esquivel G, Díaz-Calderín JM. Boerhaave syndrome with double esophageal perforation. About a case. CIR CIR 2021; 89:97-101. [PMID: 34762639 DOI: 10.24875/ciru.20001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS The delay in diagnosis contributed to the fatal outcome of the patient.
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Affiliation(s)
- Arturo Martínez-García
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | - Kymani Pérez-García
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | - Javier Pérez-Palenzuela
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | - Gimel Sosa-Esquivel
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
| | - José M Díaz-Calderín
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de La Habana, La Habana, Cuba
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16
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Simões J, Lázaro A. Transhiatal esophagectomy in Boerhaave syndrome - Case report and literature review. Int J Surg Case Rep 2021; 89:106583. [PMID: 34775326 DOI: 10.1016/j.ijscr.2021.106583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Boerhaave syndrome or spontaneous rupture of the esophagus wall is a rare life-threatening condition. It is more common in male gender and is due to a very swift rise in intraluminal pressure during vomiting. The patient usually presents with chest pain after vomiting. In some cases, there is subcutaneous emphysema in the neck or upper chest. Due to its rarity, the diagnosis is often not straightforward. Chest radiography can reveal pneumothorax, pleural effusion or pneumomediastinum, but diagnosis is more likely possible with an oral contrast X-ray study. CASE PRESENTATION This paper reports a clinical case with surgical approach, in a 68-years old patient with a 48 h period between onset of symptoms and diagnosis of a Boerhaave syndrome. Firstly, the patient was admitted with a presumptive diagnosis of pneumonia. The patient was with chest pain, fever and vomiting. An emergent transhiatal esophagectomy was performed with primary anastomosis with no significant post-operative morbidity and allowing for the patient to return to previous daily routine with a good quality of life. DISCUSSION AND CONCLUSION Boerhaave syndrome is a rare life-threatening surgical condition. Surgery is the most effective treatment. It is necessary to have a high index of suspicion. Treatment should promptly start because prognosis is related with time from diagnosis, with increasing mortality rate if no treatment is performed.
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Awadelkarim A, Shanah L, Ali M, Alhusain R, Adam O, Subahi A, Yassin AS, Lieberman R. Esophago-Pericardial Fistulae as a Sequela of Boerhaave Syndrome and Esophageal Stenting: A Case Report and Review of Literature. J Investig Med High Impact Case Rep 2021; 9:23247096211036540. [PMID: 34330166 PMCID: PMC8326610 DOI: 10.1177/23247096211036540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Esophago-pericardial fistulae is a rare and dreaded entity. Most reported cases in the literature were described in association with advanced upper gastrointestinal malignancies, prior surgical procedures, and radiofrequency atrial fibrillation ablation. It has been rarely reported in association with benign esophageal conditions. Surgery had been the mainstay of treatment, but there are increasingly reported cases treated successfully with esophageal stenting and pericardial drainage. In this article, we report a novel case of an esophago-pericardial fistulae occurring as a sequela of esophageal stent placed for the management of Boerhaave syndrome.
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Affiliation(s)
| | - Layla Shanah
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Mohammed Ali
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Rashid Alhusain
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | | | - Ahmed Subahi
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Ahmed S Yassin
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Randy Lieberman
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
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18
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Goel R, Shadrach BJ, Nayak RK, Jain A. Boerhaave syndrome: an unusual cause of bilateral exudative pleural effusion. Adv Respir Med 2021; 89:339-340. [PMID: 33881158 DOI: 10.5603/arm.a2021.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Rishabh Goel
- Department of Pulmonary Medicine, Shahi Global Hospital, Gorakhpur, India
| | - Benhur Joel Shadrach
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | | | - Anukool Jain
- Consultant Pulmonologist, Department of Pulmonary Medicine, Pushpanjali Hospital, Agra, India
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19
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Horrocks R. Boerhaave syndrome, a rare oesophageal rupture: a case report. Br Paramed J 2021; 5:49-53. [PMID: 34421375 PMCID: PMC8341059 DOI: 10.29045/14784726.2021.3.5.4.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Boerhaave syndrome is a disorder mainly unknown among ambulance staff. However, the high mortality and morbidity rates associated with this rare disorder, and the fact that other conditions present with similar symptoms, suggest that this is one disorder to add to the differential diagnosis list. This case study describes a 17-year-old male complaining of left-sided ‘pressure’-type chest pain and persistent vomiting who on examination was found to have subcutaneous emphysema present. Deceived by a differential diagnosis, the patient was transferred under the belief that he had suffered a spontaneous pneumothorax as he was tall, young and thin. This case report reviews the literature surrounding Boerhaave syndrome and how it can present.
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20
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Hayakawa S, Ogawa R, Ito S, Nakaya S, Okubo T, Sagawa H, Tanaka T, Takahashi H, Matsuo Y, Takiguchi S. Suitable Diagnosis and Treatment of Esophageal Ruptures in Cases of Non- Boerhaave Syndrome: A Comparison With Boerhaave Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211014683. [PMID: 33985358 PMCID: PMC8127747 DOI: 10.1177/23247096211014683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022] Open
Abstract
Boerhaave syndrome (BS) is frequently reported in cases of esophageal perforation; however, there are relatively few studies on non-Boerhaave syndrome (nBS). This study clarifies the appropriate diagnosis and treatment for patients with nBS among those with esophageal ruptures. Twelve patients with esophageal ruptures who underwent surgery at our department over 14 years were classified into 2 groups: 4 in the nBS group and 8 in the BS group. Patient characteristics, surgical methods, surgical outcomes, and complications were compared between the groups. The chief complaints varied between the groups. The nBS group had significantly higher preoperative C-reactive protein (P = .007) and required 5 days (median) from onset to surgery. Moreover, the perforation diameter was significantly smaller in the nBS group than in the BS group (P = .013). Suturing of the perforation site was performed during the initial surgery in 8 BS group patients (100%) and 1 nBS group patient (25%; P = .018). Only drainage was performed during the initial surgery for 3 nBS group patients (75%). The complications did not significantly differ between the groups (P = 1.000), and no deaths were reported. The chief complaints of patients with nBS are diverse, and esophageal perforation should be cited as a differential diagnosis even in the absence of vomiting or chest pain symptoms. In the initial surgery for patients with nBS, the perforation site does not necessarily need to be closed. It is treatable by second-stage surgery or by natural closing.
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Affiliation(s)
| | - Ryo Ogawa
- Nagoya City University, Nagoya City, Japan
| | - Sunao Ito
- Nagoya City University, Nagoya City, Japan
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21
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Allaway MGR, Morris PD, B Sinclair JL, Richardson AJ, Johnston ES, Hollands MJ. Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature. ANZ J Surg 2020; 91:1376-1384. [PMID: 33319446 DOI: 10.1111/ans.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Boerhaave syndrome is a rare and life-threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non-operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature. METHODS A retrospective case series was performed for consecutive patients diagnosed with Boerhaave syndrome at our institution between January 2000 and January 2020. A systematic review of the Australasian literature was also performed. RESULTS In case series, 15 patients were included (n = 2 NOM, n = 13 operative). The most common operative technique was primary repair with intercostal drainage via thoracotomy. Major complications occurred in 11 (73%) patients. Median Comprehensive Complication Index was 53.4 (interquartile range: 50). There was a significantly lower Comprehensive Complication Index associated with primary repair when compared to oesophageal resection (P = 0.01). There was one death, in the operative management group. Median length of hospital stay was 33 days (interquartile range: 58). In systematic review, 11 articles were included; four case series and seven case reports. From these, 23 patients met inclusion criteria. The majority of patients (83%) were managed operatively, with only four undergoing NOM. Seven patients died, representing an overall mortality rate of 30%. CONCLUSIONS We provide an updated overview of the management of Boerhaave syndrome within Australasia. Aggressive operative management is associated with reasonable outcomes.
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Affiliation(s)
- Matthew G R Allaway
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul D Morris
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jane-Louise B Sinclair
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Arthur J Richardson
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Emma S Johnston
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Michael J Hollands
- Department of Upper Gastrointestinal Tract Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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22
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Haba Y, Yano S, Akizuki H, Hashimoto T, Naito T, Hashiguchi N. Boerhaave syndrome due to excessive alcohol consumption: two case reports. Int J Emerg Med 2020; 13:56. [PMID: 33256613 PMCID: PMC7706278 DOI: 10.1186/s12245-020-00318-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/16/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Spontaneous esophageal rupture, or Boerhaave syndrome, is a fatal disorder caused by an elevated esophageal pressure owing to forceful vomiting. Patients with Boerhaave syndrome often present with chest pain, dyspnea, and shock. We report on two patients of Boerhaave syndrome with different severities that was triggered by excessive alcohol consumption and was diagnosed immediately in the emergency room. CASE PRESENTATION The patient in case 1 complained of severe chest pain and nausea and vomited on arrival at the hospital. He was subsequently diagnosed with Boerhaave syndrome coupled with mediastinitis using computed tomography (CT) and esophagogram. An emergency operation was successfully performed, in which a 3-cm tear was found on the left posterior wall of the distal esophagus. The patient subsequently had anastomotic leakage but was discharged 41 days later. The patient in case 2 complained of severe chest pain, nausea, vomiting, and hematemesis on arrival. He was suggested of having Boerhaave syndrome without mediastinitis on CT. The symptoms gradually disappeared after conservative treatment. Upper gastrointestinal endoscopy performed on the ninth day revealed a scar on the left wall of the distal esophagus. The patient was discharged 11 days later. In addition to the varying severity between the cases, the patient in case 2 was initially considered to have Mallory-Weiss syndrome. CONCLUSION Owing to similar histories and symptoms, Boerhaave syndrome and Mallory-Weiss syndrome must be accurately distinguished by emergency clinicians. CT can be a useful modality to detect any severity of Boerhaave syndrome and also offers the possibility to distinguish Boerhaave syndrome from Mallory-Weiss syndrome.
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Affiliation(s)
- Yuichiro Haba
- Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Emergency and Disaster Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Shungo Yano
- Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hikaru Akizuki
- Department of Emergency and Disaster Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Hashimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Naoyuki Hashiguchi
- Department of Emergency and Disaster Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Núñez-Delgado Y, Garrido-Márquez I, Díaz-Rubia L, Milena-Muñoz A, Eisman-Hidalgo M, Valero-González MÁ. Dolor torácico y shock secundarios a perforación espontánea de esófago: síndrome de Boerhaave. CIR CIR 2020; 88:18-20. [PMID: 33284265 DOI: 10.24875/ciru.20000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La perforación esofágica es la más letal de todas las perforaciones del aparato digestivo. Se presenta el caso de un varón de 65 años que acude a urgencias por un cuadro clínico de dolor torácico, vómitos e hipotensión. Se le realizó tomografía computarizada por sospecha de síndrome aórtico agudo, con hallazgos sugerentes de perforación esofágica. El síndrome de Boerhaave consiste en la rotura longitudinal del esófago sobre una pared macroscópicamente sana. Su tratamiento definitivo se realiza con cirugía durante las primeras 24 horas. El síndrome de Boerhaave debe considerarse como complicación posible en los pacientes con dolor epigástrico y vómitos, ya que es una emergencia quirúrgica con alta morbimortalidad. Esophageal perforation is the most lethal of all perforations of the digestive system. 65-year-old male who goes to the emergency department due to clinical symptoms of chest pain, vomiting and hypotension, who underwent CT scan for suspected acute aortic syndrome, with suggestive findings of esophageal perforation. Boerhaave syndrome consists of the longitudinal rupture of the esophagus on a macroscopically healthy wall. Its definitive treatment is performed with surgery during the first 24 hours. Boerhaave syndrome should be considered as a possible complication in patients with epigastric pain and vomiting, as it is a surgical emergency with high morbidity and mortality.
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Affiliation(s)
- Yolanda Núñez-Delgado
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Irene Garrido-Márquez
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Laura Díaz-Rubia
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
| | - Ana Milena-Muñoz
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Cecilio, Granada, España
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Abstract
Spontaneous oesophagus rupture, also known as Boerhaave syndrome, is a rare but near-fatal medical condition and despite recent medical advancements, it remains a diagnostic challenge for front-door clinicians. The authors describe a similar presentation in an elderly gentleman who presented to the emergency department with sudden chest pain post vomiting. His initial chest radiograph showed bilateral dense consolidations and pleural effusions, and was treated as sepsis secondary to bilateral pneumonia. He underwent computed tomography pulmonary angiogram to rule out pulmonary embolism because of his chest pain with elevated D-dimer which confirmed the diagnosis of oesophagus rupture. His care was transferred to Surgical and Intensive care colleagues with plans for radiological chest drain insertion to limit contamination of mediastinum, however the patient became hypoxic and hypotensive and despite maximal organ support passed away within 6 hours of admission. Retrospect review of chest radiograph revealed Peri-oesophageal air tracking, a sign of Boerhaave syndrome. The aim of this case is to emphasise the importance of raising the suspicion of Boerhaave syndrome in patients with sudden chest pain, unexplained pleural effusion or pneumothorax with a history of recent vomiting as early diagnosis holds the key to prompt lifesaving management.
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Affiliation(s)
| | | | - Adnan Agha
- Consultant Acute Medicine/Diabetes & Endocrinology, University Hospitals of Derby and Burton, UK
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Harikrishnan S, Murugesan CS, Karthikeyan R, Manickavasagam K, Singh B. Challenges faced in the management of complicated Boerhaave syndrome: a tertiary care center experience. Pan Afr Med J 2020; 36:65. [PMID: 32754292 PMCID: PMC7380874 DOI: 10.11604/pamj.2020.36.65.23666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022] Open
Abstract
Spontaneous esophageal perforation is rare and is associated with high morbidity and mortality. A spectrum of various surgical modalities ranging from primary surgical repair to esophagectomy is available for its management. The optimal management of patients presenting late in a hemodynamically stable condition is not clearly defined in the literature. A retrospective review of all patients with Boerhaave syndrome managed by a single surgical team in a tertiary care center between 2008 and 2019 was performed (n = 16). Eleven patients were initially managed in the medical intensive care unit (MICU) as non-esophageal cause and 5 patients were referred after failed management (conservative/endoscopic). Demographics, clinical presentation, characteristics of perforation, initial diagnosis, and treatment were analyzed. All patients were males with a mean age of 42.2 years. A history of ethanol use was present in 6 patients. The median delay in diagnosis and referral was 16 days (range: 11-40 days). The common presenting symptoms were chest pain (n=11), dyspnoea (n=10), vomiting (n=4) and cough (n=2). The perforation was directed into right, left, and bilateral pleural cavities in 6, 8, and 2 patients respectively. The location of perforation was distal esophagus except for one patient. One patient was successfully treated with conservative management. The remaining patients underwent esophagectomy as a definitive surgical procedure. There was no significant postoperative morbidity and mortality. Esophagectomy can be done as a one-stage definitive procedure for patients with Boerhaave syndrome who present late in a hemodynamically stable condition with acceptable morbidity and good long term outcome.
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Affiliation(s)
- Sakthivel Harikrishnan
- Surgical Gastroenterology, Government Stanley Medical College and Hospital, Chennai, India
| | | | - Raveena Karthikeyan
- Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Kanagavel Manickavasagam
- Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Balaji Singh
- Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Arias-González L, Rey-Iborra E, Ruiz-Ponce M, Laserna-Mendieta EJ, Arias Á, Lucendo AJ. Esophageal perforation in eosinophilic esophagitis: A systematic review on clinical presentation, management and outcomes. Dig Liver Dis 2020; 52:245-252. [PMID: 31836305 DOI: 10.1016/j.dld.2019.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
There is evidence of an increased fragility in the inflamed esophagus of patients with eosinophilic esophagitis (EoE). We performed a systematic review on presentation, management and outcomes of and surgical interventions for esophageal perforation in these patients, by searching in the MEDLINE, Embase and Scopus databases. Of the 599 references identified, 41 full-papers and 9 abstract met the inclusion criteria. Overall, 76 esophageal perforation episodes in 70 individual patients aged between 9 and 65 years were reported. 51 patients had not been diagnosed with EoE at the time of perforation; 14 patients had an untreated disease and the remaining were non responsive to therapy. Acute or progressive pain after long-lasting dysphagia and food impaction was the most common symptom leading to diagnosis in 42 patients who presented with Boerhaave syndrome. Pushing impacted food into the stomach led to perforation in 5 cases. Eight episodes appeared after dilation. CT scans demonstrated perforation in 82.4% of patients. Conservative management (including esophageal stenting) was used in 67.1% patients. The 25 remaining patients underwent surgery. Recovery was uneventful in the vast majority of patients. No death was reported. Active inflammation due to undiagnosed or untreated EoE was present in most cases of esophageal perforation. Conservative treatment of perforation should always be considered in EoE.
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Affiliation(s)
- Laura Arias-González
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Esther Rey-Iborra
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
| | - Miriam Ruiz-Ponce
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Emilio J Laserna-Mendieta
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Ángel Arias
- Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Research Unit, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigacion Biomedica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain.
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Mureșan M, Mureșan S, Balmoș I, Sala D, Suciu B, Torok A. Sepsis in Acute Mediastinitis - A Severe Complication after Oesophageal Perforations. A Review of the Literature. J Crit Care Med (Targu Mures) 2019; 5:49-55. [PMID: 31161141 PMCID: PMC6534941 DOI: 10.2478/jccm-2019-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition. DIAGNOSIS AND TREATMENT Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage. CONCLUSIONS The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.
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Affiliation(s)
- Mircea Mureșan
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Simona Mureșan
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Ioan Balmoș
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Daniela Sala
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
| | - Bogdan Suciu
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Thoracic Surgery Department, Târgu Mureș, Romania
| | - Arpad Torok
- University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2, Târgu Mureș, Romania
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28
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Agrawal V, Aggarwal D. Undiagnosed spontaneous oesophageal rupture presenting as right hydropneumothorax. Indian J Thorac Cardiovasc Surg 2019; 35:111-114. [PMID: 33060987 DOI: 10.1007/s12055-018-0719-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 05/30/2023] Open
Abstract
Spontaneous oesophageal rupture has been a known ailment with a high morbidity and mortality. Various factors contribute to its predisposition such as preexisting oesophageal diseases, increased intraluminal pressure, neurogenic causes, and iatrogenic-commonest being instrumentation. We present the case of a 26-year-old male with features of right hydropneumothorax for which an intercostal chest drain (ICD) was inserted that yielded turbid fluid with suspicion of it being gastric contents. With a diagnosis of diaphragmatic hernia and gut/bowel injury caused due to intercostal drain, the patient underwent emergency exploratory laparotomy. No abnormality was detected and possibility of oesophageal injury/rupture was contemplated though ruled out on investigations. The patient improved with medical treatment of empyema and discharged. The patient was lost to follow-up until after a year the patient reported to surgery OPD with complaints of dysphagia. A barium swallow revealed thoracic oesophageal benign stricture thus confirming our suspicion of spontaneous oesophageal rupture that had occurred a year ago. Knowledge about atypical presentations of oesophageal rupture is important so as to be more aware of this possibility.
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Affiliation(s)
- Vivek Agrawal
- Department of Surgery, University College of Medical Sciences, Delhi, 310 SFS DDA Flat, Hauz Khas Apartments, Aurobindo Marg, New Delhi, 110016 India
| | - Deepanshu Aggarwal
- Department of Surgery, University College of Medical Sciences, Delhi, 35 Vigyan Vihar, Delhi, 110092 India
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29
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Pinto MJF, Rodrigues P, Almeida L, Leitão A, Flores L, Gomes A, Rocha G, Friões F. Boerhaave Syndrome in an Elderly Man. Eur J Case Rep Intern Med 2018; 5:000944. [PMID: 30755979 PMCID: PMC6346888 DOI: 10.12890/2018_000944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 11/05/2022] Open
Abstract
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment. LEARNING POINTS Boerhaave syndrome is a complete rupture of the oesophageal wall secondary to a sudden increase in intraluminal oesophageal pressure, often in the lower third and left lateral position of the oesophagus.The management of Boerhaave syndrome depends on the time of diagnosis and clinical presentation and includes conservative, endoscopic and surgical approaches.Curative, aggressive approaches focused on the treatment of disease are often not appropriate for an aging population, hence the need for a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.
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Affiliation(s)
| | - Pedro Rodrigues
- Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
| | - Leonor Almeida
- Pneumology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Alexandra Leitão
- Internal Medicine Department, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Luís Flores
- Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
| | - André Gomes
- Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
| | - Gonçalo Rocha
- Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
| | - Fernando Friões
- Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal
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30
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Y K, F AB, A T, D H. Boerhaave syndrome in an elderly man successfully treated with 3-month indwelling esophageal stent. Radiol Case Rep 2018; 13:1084-1086. [PMID: 30228849 PMCID: PMC6137399 DOI: 10.1016/j.radcr.2018.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 11/08/2022] Open
Abstract
Boerhaave syndrome refers to a spontaneous perforation of the esophagus that results from severe straining or vomiting. This uncommon situation may lead to serious outcome with chemical mediastinitis, and is associated with high morbidity and mortality. Surgery, although associated with high morbidity and mortality remains the treatment of choice, whereas endoscopic management with stent placement is preserved to treat inoperable patients. Removal of the stent is generally recommended after 4-6 weeks. We report a case of an elderly patient who presented with a large complicated Boerhaave's mid-esophageal perforation, with a complete recovery after a 3-month treatment with a long esophageal stent.
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Affiliation(s)
- Kopelman Y
- Gastroenterology department; Hillel Yaffe medical center, Hadera, Israel
| | - Abu Baker F
- Gastroenterology department; Hillel Yaffe medical center, Hadera, Israel
| | - Troiza A
- Surgery department; Hillel Yaffe medical center, Hadera, Israel
| | - Hebron D
- Readiology department; Hillel Yaffe medical center, Hadera, Israel
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31
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Abstract
Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy obstruction has not been reported in current literature. We present a rare case of two concurrent surgical emergencies in a patient with Boerhaave syndrome and small bowel obstruction. A 38-year-old woman presented with sudden onset severe central chest pain associated with breathlessness. She had a history of Crohn's disease, which had been treated with pancolectomy and ileostomy. Clinical examination showed an extensive palpable surgical emphysema extending from the neck to the pelvis with a distended abdomen. Computed tomography contrast of the chest and abdomen reported bilateral pneumothoraces, ruptured oesophagus and distended small bowel secondary to obstruction at the ileostomy. She was referred to the nearest cardiothoracic centre for an urgent assessment. Unfortunately she passed away shortly after the scan. Ruptured oesophagus is associated with a high mobidity and mortality if it is not recognised, so early diagnosis and prompt treatment is crucial in reducing the mortality rate. There is a strong association between stoma formation and incidence of small bowel obstruction but no difference between an ileostomy and colostomy. This case helps to illustrate the challenging management of chronic recurring abdominal obstruction and the delicate balance of risk of complication versus benefit of various management being surgical or conservative. All general surgeons should be wary of the potential complication of oesophageal perforation secondary to intestinal obstruction.
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Affiliation(s)
- D Yap
- Emergency Department, Royal Blackburn Hospital, Blackburn, UK
| | - M Ng
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - N Mbakada
- Emergency Department, Royal Blackburn Hospital, Blackburn, UK
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32
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Lieu MT, Layoun ME, Dai D, Soo Hoo GW, Betancourt J. Tension hydropneumothorax as the initial presentation of Boerhaave syndrome. Respir Med Case Rep 2018; 25:100-103. [PMID: 30101056 PMCID: PMC6083431 DOI: 10.1016/j.rmcr.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
Boerhaave syndrome, a rare yet frequently fatal diagnosis, is characterized by the spontaneous transmural rupture of the esophagus. The classic presentation of Boerhaave syndrome is characterized by Mackler's triad, consisting of chest pain, vomiting, and subcutaneous emphysema. However, Boerhaave syndrome rarely presents with all the features of Mackler's triad; instead, the common presentation of Boerhaave syndrome includes chest or epigastric pain, severe retching and vomiting, dyspnea, and shock. These symptoms are typically misdiagnosed as cardiogenic in origin. Due to its atypical presentation, rarity, and mimicry of emergent conditions, diagnosis of Boerhaave syndrome is often delayed, resulting in a high mortality rate at the time of diagnosis and with a subsequent exponential increase in mortality if treatment is delayed by greater than 48 hours. Here, we report two atypical presentations of Boerhaave syndrome presenting as tension hydropneumothorax and review ten previously reported cases of Boerhaave syndrome presenting as tension hydropneumothorax. This review serves to raise clinician awareness about the expansive and elusive ways by which esophageal perforation may present, and thereby facilitate timely and potentially life-saving diagnosis.
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Affiliation(s)
- Michelle-Thao Lieu
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Michael E Layoun
- Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health and Sciences University, USA
| | - David Dai
- Department of Medicine, Pulmonary & Critical Care Section, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Guy W Soo Hoo
- Department of Medicine, Pulmonary & Critical Care Section, David Geffen School of Medicine at University of California, Los Angeles, USA.,Department of Medicine, Pulmonary & Critical Care Section, VA Greater Los Angeles Healthcare System, USA
| | - Jaime Betancourt
- Department of Medicine, Pulmonary & Critical Care Section, David Geffen School of Medicine at University of California, Los Angeles, USA.,Department of Medicine, Pulmonary & Critical Care Section, VA Greater Los Angeles Healthcare System, USA
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33
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Sato H, Ishida K, Sasaki S, Kojika M, Endo S, Inoue Y, Sasaki A. Regulating migration of esophageal stents - management using a Sengstaken-Blakemore tube: A case report and review of literature. World J Gastroenterol 2018; 24:3192-3197. [PMID: 30065565 PMCID: PMC6064967 DOI: 10.3748/wjg.v24.i28.3192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/17/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Stent migration, which causes issues in stent therapy for esophageal perforations, can counteract the therapeutic effects and lead to complications. Therefore, techniques to regulate stent migration are important and lead to effective stent therapy. Here, in these cases, we placed a removable fully covered self-expandable metallic stent (FSEMS) in a 52-year-old man with suture failure after surgery to treat Boerhaave syndrome, and in a 53-year-old man with a perforation in the lower esophagus due to acute esophageal necrosis. At the same time, we nasally inserted a Sengstaken-Blakemore tube (SBT), passing it through the stent lumen. By inflating a gastric balloon, the lower end of the stent was supported. When the stent migration was confirmed, the gastric balloon was lifted slightly toward the oral side to correct the stent migration. In this manner, the therapy was completed for these two patients. Using a FSEMS and SBT is a therapeutic method for correcting stent migration and regulating the complete migration of the stent into the stomach without the patient undergoing endoscopic rearrangement of the stent. It was effective for positioning a stent crossing the esophagogastric junction.
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Affiliation(s)
- Hisaho Sato
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
| | - Kaoru Ishida
- Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
| | - Shusaku Sasaki
- Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
| | - Masahiro Kojika
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
- Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
| | - Shigeatsu Endo
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
- Morioka Yuai Hospital, Morioka, Iwate 020-0834, Japan
| | - Yoshihiro Inoue
- Department of Critical Care Medicine, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, School of Medicine, Morioka, Iwate 020-0023, Japan
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34
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Abstract
Spontaneous perforation of the esophagus (Boerhaave syndrome) is a rare disease that poses a serious surgical challenge. The analysis of literature concerning the Boerhaave syndrome reveled cases of recurrent spontaneous perforation of the esophagus. The incidental nature of this condition calls for more accurate assessment of all such cases. The authors made a detailed evaluation of the data obtained from eight reports of recurrent Boerhaave syndrome. The data is presented as a summary table comparing the clinical course and outcomes of patients with the primary Boerhaave syndrome as well as recurrent Boerhaave syndrome.
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Affiliation(s)
- Marek Rokicki
- Katedra i Klinika Chirurgii Klatki Piersiowej w Zabrzu, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
| | - Wojciech Rokicki
- Katedra i Klinika Chirurgii Klatki Piersiowej w Zabrzu, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Moj
- Katedra i Klinika Chirurgii Klatki Piersiowej w Zabrzu, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
| | - Tamer Bsoul
- Katedra i Klinika Chirurgii Klatki Piersiowej w Zabrzu, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
| | - Mateusz Rydel
- Katedra i Klinika Chirurgii Klatki Piersiowej w Zabrzu, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
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35
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Tanaka H, Uemura N, Nishikawa D, Oguri K, Abe T, Higaki E, Hosoi T, An B, Hasegawa Y, Shimizu Y. Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report. Surg Case Rep 2018; 4:54. [PMID: 29884971 PMCID: PMC5993691 DOI: 10.1186/s40792-018-0462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome. To the best of our knowledge, this is the first report of a patient with esophageal rupture occurring during CRT for hypopharyngeal cancer with stenosis. Case presentation A 66-year-old man with a sore throat was referred to our hospital. He was found to have stage IVA hypopharyngeal cancer, cT2N2bM0, and underwent radical concurrent CRT consisting of weekly cisplatin (30 mg/m2) and radiation (70 Gy/35fr), for larynx preservation. On day 27 of treatment, he vomited, which was followed by severe left chest pain radiating to the back and the upper abdomen. Enhanced computed tomography (CT) revealed extensive mediastinal emphysema and a small amount of left pleural effusion. Esophagography revealed extravasation into the left thoracic cavity, and the patient was diagnosed with an intrathoracic rupture type of Boerhaave syndrome. He underwent emergency left thoracotomy 21 h after the onset. The ruptured esophageal wall was primarily repaired by closure with two-layer suturing and covered by a pedicled omentum. A jejunostomy tube was placed for postoperative enteral nutrition. On postoperative day (POD) 16, the patient was transferred to head and neck surgery to finish CRT and was discharged on POD 56. He has survived without relapse for 11 months after surgery. Conclusion Patients with head and neck cancer are at risk for developing Boerhaave syndrome during CRT. In addition, since such patients often are in poor overall condition because of immunosuppression and protracted wound healing, Boerhaave syndrome can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
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Affiliation(s)
- Hideharu Tanaka
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Norihisa Uemura
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Keisuke Oguri
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Byonggu An
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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Abstract
OBJECTIVES Surgical repair has been the most common treatment of esophageal effort rupture (Boerhaave syndrome). Stent-induced sealing of the perforation has increasingly been used with promising results. We present our eight years´ experience with stent-based and organ-preserving treatment. MATERIALS AND METHODS Medical records of 15 consecutive patients with Boerhaave syndrome from February 2007 to May 2015 were retrospectively registered in a database. Treatment was sealing of the perforation by stenting, chest tube drainage and débridement of the contaminated thorax. After median 25 months nine out of 10 patients responded to questions on fatigue and Ogilvie's dysphagia score. RESULTS Fifteen patients, aged median 67.5 years (range 39-88), had a primary hospital stay of 20 days (range 1-80 days). Overall in-hospital mortality was 13%. Observation time was 44 months (range 0-87) and 10 patients were alive of August 2017. Ten patients (67%) needed surgical chest débridement. Five patients (33%) were restented for leakage, migration and for stent removal. Eleven patients (73%) had complications, which included pleural empyema (n = 4), fatal aortic bleeding, lung arterial bleeding, lung embolism, drain-induced lung laceration and respiratory failure. Dysphagia score was low (median 0.5) meaning that they were able to feed themselves. Total fatigue score (mean 14.6) was slightly increased (p = .05) compared with a reference population. CONCLUSIONS The mortality rate after initial stenting of effort rupture seems to be comparable to standard surgical repair. Most patients required further intervention, either by restenting and/or surgical débridement. The functional result in these patients was satisfactory.
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Affiliation(s)
- Tobias Hauge
- a Department of Surgery , Drammen Hospital , Drammen , Norway
| | | | - Egil Johnson
- c Department of Pediatric and Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway.,d Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Bjørn Hofstad
- e Department of Gastroenterology , Oslo University Hospital , Oslo , Norway
| | - Hans-Olaf Johannessen
- c Department of Pediatric and Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway
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Okamoto H, Onodera K, Kamba R, Taniyama Y, Sakurai T, Heishi T, Teshima J, Hikage M, Sato C, Maruyama S, Onodera Y, Ishida H, Kamei T. Treatment of spontaneous esophageal rupture ( Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018; 10:2206-2212. [PMID: 29850124 DOI: 10.21037/jtd.2018.03.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The mortality rate of spontaneous esophageal rupture remains 20% to 40% due to severe respiratory failure. We have performed thoracoscopic surgery for esophageal disease at our department since 1994. Sivelestat sodium hydrate reportedly improves the pulmonary outcome in the patients with acute lung injury (ALI). Methods We retrospectively evaluated the usefulness of thoracoscopic surgery and perioperative administration of sivelestat sodium hydrate for spontaneous esophageal rupture in 12 patients who underwent thoracoscopy at our department between 2002 and 2014. Results The patient cohort included 11 males and one female (median age, 61 years). The lower left esophageal wall was perforated in all patients. Surgical procedures consisted of thoracoscopic suture and thoracic drainage in six patients, transhiatal suture and thoracoscopic thoracic drainage in five, and thoracoscopic esophagectomy and thoracic drainage in one. The median time from onset to surgery was 8 hours with a surgical duration of 210 minutes, blood loss 260 mL, postoperative ventilator management 1 day, intensive care unit (ICU) stay 5 days, and interval to restoration of oral ingestion 13 days. Postoperative complications included respiratory failure in four patients, pyothorax in three, and leakage in one. There was no instance of perioperative mortality. Regarding perioperative administration of sivelestat sodium hydrate, the postoperative arterial oxygen partial pressure-to-fractional inspired oxygen ratio (P/F) and C-reactive protein (CRP) levels in the administration group were significantly better than those in the non-administration group on postoperative days 4 (P=0.035) and 5 (P=0.037), respectively. In contrast, there was no significant difference between the groups in median time of ventilator management, ICU stay, oral ingestion following surgery, or hospital stay. Conclusions Thoracoscopic surgery obtained acceptable results in all patients, including two with a significant time elapse from onset to treatment. Furthermore, sivelestat sodium hydrate was suggested to help improve postoperative respiration and inflammatory response.
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Affiliation(s)
- Hiroshi Okamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ko Onodera
- Department of General Practitioner Development, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Rikiya Kamba
- Department of Surgery, Osaki Citizen Hospital, Osaki, Japan
| | - Yusuke Taniyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Sakurai
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takahiro Heishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Jin Teshima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Makoto Hikage
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Sendai City Hospital, Sendai, Japan
| | - Chiaki Sato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shota Maruyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yu Onodera
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hirotaka Ishida
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
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38
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Ishikawa Y, Tagami T, Hirashima H, Fukuda R, Moroe Y, Unemoto K. Endoscopic Treatment of Boerhaave Syndrome Using Polyglycolic Acid Sheets and Fibrin Glue: A Report of Two Cases. J NIPPON MED SCH 2018; 84:241-245. [PMID: 29142186 DOI: 10.1272/jnms.84.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Boerhaave syndrome, the spontaneous perforation of the esophagus, is an emergency, life-threatening condition. Current endoscopic treatment options include clipping and stenting, but the use of polyglycolic acid (PGA) sheets for treating the condition has not been reported. In recent years, PGA sheets have been used after endoscopic submucosal dissection to prevent perforations and stricture formation in patients treated for early-stage carcinoma. We report the cases of two patients with Boerhaave syndrome who were successfully treated using PGA sheets. The present clinical outcomes suggest that the use of PGA sheets is feasible and safe for treating patients with Boerhaave syndrome, and that they may be another treatment option.
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Affiliation(s)
- Yumiko Ishikawa
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | | | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
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Do YW, Lee CY, Lee S, Kim HE, Kim BJ, Lee JG. Successful Management of Delayed Esophageal Rupture with T-Tube Drainage Using Video-Assisted Thoracoscopic Surgery. Korean J Thorac Cardiovasc Surg 2016; 49:478-480. [PMID: 27965929 PMCID: PMC5147477 DOI: 10.5090/kjtcs.2016.49.6.478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/16/2022]
Abstract
Spontaneous perforation of the esophagus after forceful vomiting is known as Boerhaave syndrome, a rare and life-threatening condition associated with a high rate of mortality. The management of Boerhaave syndrome is challenging, especially when diagnosed late. Herein, we report the successful management of late-diagnosed Boerhaave syndrome with T-tube drainage in a 55-year-old man. The patient was transferred to our institution 8 days after the onset of symptoms, successfully managed by placing a T-tube, and was discharged on postoperative day 46 without complications.
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Affiliation(s)
- Young Woo Do
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine
| | - Bong Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine
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40
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Kimura-Kataoka K, Fujihara J, Kurata S, Takinami Y, Inoue K, Yasuda T, Takeshita H. An autopsy case of spontaneous esophageal perforation ( Boerhaave syndrome). Leg Med (Tokyo) 2016; 23:5-9. [PMID: 27890104 DOI: 10.1016/j.legalmed.2016.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/24/2022]
Abstract
A 45-year-old male, an alcohol addict with asthma, was found dead in his home, after several days of continued drinking. A forensic autopsy was performed 3days after the discovery of his death in order to specify the cause of death. A longitudinal perforation penetrating all layers of the esophagus measuring 1.8cm was present on the left wall approximately 2.0cm from the gastroesophageal junction. There were 1900mL of greenish to brownish turbid liquid in the left pleural cavity and 150mL of greenish viscous liquid in the stomach. Histopathologically, an infiltration of numerous neutrophils was evident in the submucosa layer, proper muscular layer, and serous membrane of the esophagus, corresponding to the esophageal laceration. The serum C-reactive protein (CRP) concentration was determined to be 3.1mg/dL. The alcohol concentrations were determined to be 1.49mg/g in the right cardiac blood, 1.31mg/g in the left cardiac blood, and 2.48mg/g in urine. Based upon the autopsy and histopathological findings, as well as the biochemical and toxicological analyses, we concluded that the cause of death was respiratory failure by pleural effusion, resulting from spontaneous esophageal perforation. This was the first report of a spontaneous esophageal perforation eventually causing respiratory failure.
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Affiliation(s)
- Kaori Kimura-Kataoka
- Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan.
| | - Junko Fujihara
- Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan
| | | | - Yoshikazu Takinami
- Department of Emergency and Critical Care Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ken Inoue
- Department of Public Health, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshihiro Yasuda
- Division of Medical Genetics and Biochemistry, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Haruo Takeshita
- Department of Legal Medicine, Shimane University School of Medicine, Izumo, Shimane, Japan
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41
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Crispin MD, Chan KJ, Winter N, Hii M. Esophageal Apoplexy. J Gastrointest Surg 2016; 20:1535-6. [PMID: 27271541 DOI: 10.1007/s11605-016-3184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/29/2016] [Indexed: 01/31/2023]
Abstract
Oesophageal apoplexy or intramural haematoma of the oesophagus (IHE) is a rare condition with a pattern of presentation that can mimic sinister pathologies. Diagnosis requires a high index of suspicion, and the exclusion of an oesophageal perforation or oesophageal malignancy is important. Investigations include computer topography (CT) and contrast swallow studies as well as a gastroscopy. Management is mainly supportive with resolution of symptoms typically occurring rapidly. We present two cases of this rare condition, with accompanying images.
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Oh MK, Jeon WJ, Cho SY, Kwon YD, Kim KH. Development of bilateral tension pneumothorax under anesthesia in a Boerhaave's syndrome patient: a case report. Korean J Anesthesiol 2016; 69:175-80. [PMID: 27066209 PMCID: PMC4823415 DOI: 10.4097/kjae.2016.69.2.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 02/03/2015] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.
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Affiliation(s)
- Mi Kyung Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sang Yun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Yong Deok Kwon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Kyoung Hun Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
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43
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Naitoh H, Fukuchi M, Kiriyama S, Fukasawa T, Tabe Y, Yamauchi H, Yoshida T, Saito K, Hagiwara K, Kuwano H. Recurrent, spontaneous esophageal ruptures associated with antiphospholipid antibody syndrome: report of a case. Int Surg 2014; 99:842-5. [PMID: 25437597 DOI: 10.9738/INTSURG-D-13-00204.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old man was admitted to our hospital with a spontaneous esophageal rupture (Boerhaave syndrome) and was successfully treated. Eight years after the first incident, he was readmitted with a recurrent rupture. Recurrence of Boerhaave syndrome is extremely rare, with only 7 cases reported in the English literature. During treatment, the patient was also diagnosed with antiphospholipid syndrome (APS). Although APS is known to cause a variety of symptoms due to vascular thrombosis, recurrence of Boerhaave syndrome, coincident with APS, has never been reported. The pathogenesis of Boerhaave syndrome has not been clearly determined. This report serves to increase awareness of the risk of APS, which results in an increased risk of spontaneous rupture of the esophagus.
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Abstract
Epigastric pain is an extremely common complaint in the emergency department and has an associated broad differential diagnosis. In the differential it is important to consider cardiac causes that may be mistaken for gastrointestinal disorders as well as various serious intra-abdominal causes. This article highlights the limitations in laboratory testing and guides providers through the appropriate considerations for advanced imaging. Special attention is focused on acute pancreatitis, esophageal emergencies, and peptic ulcer disease/gastritis and their associated complications.
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Affiliation(s)
- Patrick Robinson
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24016, USA.
| | - John C Perkins
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, 1 Riverside Circle, 4th Floor, Roanoke, VA 24016, USA
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45
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Dżeljilji A, Rokicki W, Rokicki M. A rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome. Kardiochir Torakochirurgia Pol 2015; 12:262-5. [PMID: 26702287 DOI: 10.5114/kitp.2015.54467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/11/2013] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
Esophageal perforation is the fastest progressing and the most life-threatening disruption of gastrointestinal tract continuity. It must be regarded as an emergency condition that requires early diagnosis as well as very aggressive and rapid implementation of treatment in order to avoid serious complications and death. Methods of treatment for spontaneous esophageal perforation continue to be a matter of controversy. However, all authors emphasize that ultimate success depends largely on the time taken to establish the diagnosis. The authors of this study describe a rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome.
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46
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Vallabhajosyula S, Sundaragiri PR, Berim IG. Boerhaave Syndrome Presenting as Tension Pneumothorax: First Reported North American Case. J Intensive Care Med 2015; 31:349-52. [PMID: 26395053 DOI: 10.1177/0885066615606698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/27/2015] [Indexed: 11/16/2022]
Abstract
Tension pneumothorax is a rare and potentially life-threatening clinical complication. A 43-year-old Caucasian woman with type 1 diabetes mellitus presented with nausea and retching and examination revealed dehydration. Laboratory parameters were consistent with a diagnosis of diabetic ketoacidosis, which responded to therapy. Suddenly, 30 hours later, she developed cardiorespiratory compromise due to a tension pneumothorax. After emergent decompression and catheter placement, computerized tomographic scan of the chest demonstrated esophageal-pleural fistula confirming Boerhaave syndrome as the etiology for the pneumothorax. The patient underwent emergent esophagectomy with pleural washout with a subsequent gastric pull-up surgery. Boerhaave syndrome frequently presents atypically with chest pain, dyspnea, and nausea. It communicates with the left pleural space in 80% to 90% of cases, but <5% of cases involve the right pleural cavity. Unexplained and rapidly progressive pleural effusions have been associated with this entity. Only 4 cases of Boerhaave syndrome causing tension pneumothorax have been reported in the literature so far.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ilya G Berim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
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Abstract
INTRODUCTION Hyperemesis gravidarum describes persistent vomiting leading to fluid and electrolyte imbalance. It is the commonest reason for admission in the first half of pregnancy. We describe a case of Hamman syndrome secondary to hyperemesis gravidarum. We also discuss Boerhaave syndrome: a particularly rare condition with only a handful of cases being described in the literature. CASE PRESENTATION A 17 year old admitted with hyperemesis gravidarum was diagnosed with Hamman syndrome after complaining of chest pain due to the presence of subcutaneous emphysema and pneumomediastinum on chest radiograph. She was treated conservatively for potential ruptured oesophagus but then self-discharged against medical advice. CONCLUSION Subcutaneous emphysema is an alarming finding in any pregnancy and should be treated in a timely and cautious manner. This case report adds weight to the previous literature advocating a conservative versus surgical approach to the management of a woman with Hamman syndrome secondary to hyperemesis gravidarum.
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Affiliation(s)
- Gordon M Buchanan
- Specialty Trainee in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, University Hospital Crosshouse, UK
| | - Vivian Franklin
- Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, University Hospital Crosshouse, UK
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49
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Gupta A, Rizvi I, Srivastava VK, Debnath J, Kapur BN, Khanna VN, Aziz A. Spontaneous pneumomediastinum. Med J Armed Forces India 2013; 71:S85-8. [PMID: 26265882 DOI: 10.1016/j.mjafi.2013.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/21/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ankush Gupta
- Graded Specialist (Medicine), Military Hospital Jodhpur, C/o 56 APO, India
| | - Imran Rizvi
- Assistant Professor (Medicine), Jawahar Lal Nehru Medical College & Hospital, Aligarh Muslim University, UP, India
| | | | - Jyotindu Debnath
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - B N Kapur
- Consultant (Medicine & Oncology), Army Hospital (R&R), New Delhi, India
| | - V N Khanna
- Senior Advisor (Medicine), Military Hospital Kirkee, India
| | - Atiya Aziz
- Medical Officer (Obst & Gynaec), Military Hospital Jodhpur, C/o 56 APO, India
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50
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Houari N, Kanjaa N. [Rapidly fatal Boerhaave syndrome: an emergency not to ignore]. Pan Afr Med J 2013; 14:73. [PMID: 23646209 PMCID: PMC3641927 DOI: 10.11604/pamj.2013.14.73.2467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/19/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nawfal Houari
- Service de Réanimation Polyvalente, CHU Hassan II, Fès, Maroc
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