Abstract
Background
Spontaneous oesophageal rupture (Boerhaave’s syndrome) is rare, and carries a high attendant risk of mortality.
Methods
A retrospective eight-year review from a tertiary unit.
Results
Eighteen patients were managed, with a mean age of 57 (39–88 years). Eight patients presented early and underwent surgery, seven with primary closure and one with exclusion and diversion. There was one death in this group. Ten patients were managed conservatively. In this group, two underwent an oesophagectomy because of failed conservative measures, and four had an endoprosthesis inserted. One patient died in this group on the first admission, but two patients with stents in situ died from massive bleeding relating to an aorto-oesophageal fistula at 39 days and 189 days respectively following presentation.
Conclusions
Surgical intervention remains the gold standard when the diagnosis is made early For late diagnoses, this series suggests caution in the use of endoprostheses.
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References
Boerhaave H. Atrocis, Nec Descripti Pruis, Morbid Historia: Secundum Medicae Artis Leges Conscripta. Lugduni Batavorum: Boutesteniana, 1724.
Barrett NR. Spontaneous perforation of the oesophagus; review of the literature and report of 3 new cases.Thorax 1946; 1:48–56.
Lawrence DR, Ohri SK, Moxon RE et al. Primary oesophageal repair for Boerhaave’s syndrome.Ann Thorac Surg 1999; 67:818–20
Bufkin BL, Miller Jl, Mansour KA. Esophageal perforation: Emphasis on management.Ann Thorac Surg 1996; 61: 1447–52
Pate JW, Walker WA, Cole FH Jr et al. Spontaneous Rupture of the oesophagus: a 30 year experience.Ann Thoracic Surg 1989; 47:689–692
Brauer RB, Liebermann-Meffert D, Stein HJ, Bartels H, Siewert JR. Boerhaave’s Syndrome: analysis of the literature and report of 18 new cases.Dis Esophagus 1997; 10:64–8
Shenfine J, Dresner SM, Vishwanath Y, Hayes N, Griffin SM. Management of spontaneous rupture of the oesophagus.Br J Surg 2000; 87:362–73.
Mackler SA. Spontaneous rupture of the esophagus: An experimental and clinical study.Surg Gynaec Obstet 1952; 92:345–50.
Jougon J, McBride T, Delcambre F et al. Primary oesophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment.Eur J Cardithorac Surg 2004; 25:475–479
Altorjay A, Kiss J, Voros A. The role of esophagectomy in the management of oesophageal perforations.Ann Thorac Surg 1998; 65:1433–6
Ojaima H, Kuwano H, Sasaki S, Fujisawa T, Ishibashi Y. Successful late management of spontaneous esophageal rupture using T-tube mediastinoabdominal drainage.Am J Surg 2001; 182:192–6
Larrieu AJ, Kieffler R. Boerhaave’s syndrome: report of a case treated non-operativelyAnn Surg 1976; 183:401–408
Tsunoda S, Shimada Y, Watanabe G, Nakau M, Imamura M. Covered metallic stent of a patient with spontaneous rupture of the esophagus.Dis Esophagus 2001; 14: 254–7.
Lawrence DR, Ohri SK, Moxon RE et al. Primary oesophageal repair for Boerhaave’s syndrome.Ann Thorac Surg 1999; 67: 818–20
Harries K, Masoud A, Brown TH, Richards DG. Endoscopic placement of fibrin sealant as a treatment for long-standing Boerhaave’s fistula.Dis Esophagus 2004;17:348–50
Davies AP, Vaughan R. Expanding mesh stent in the emergency treatment of Boerhaave’s syndrome.Ann Thorac Surg 1999; 67:1482–3
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Prichard, R., Butt, J., AI-Sariff, N. et al. Management of spontaneous rupture of the oesophagus (Boerhaave’s syndrome): Single centre experience of 18 cases. Ir J Med Sci 175, 66–70 (2006). https://doi.org/10.1007/BF03167971
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DOI: https://doi.org/10.1007/BF03167971