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Giovanni Vicidomini - One of the best experts on this subject based on the ideXlab platform.
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unusual case of Boerhaave Syndrome diagnosed late and successfully treated by abbott s t tube
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Mario Santini, Alfonso Fiorello, Salvatore Cappabianca, Giovanni VicidominiAbstract:Spontaneous rupture of the esophagus is a rare and potentially fatal condition with an overall mortality rate of 20% to 50%. We report a rare case of Boerhaave Syndrome that was successfully treated with Abbott’s T-tube. Clinical Summary A 33-year-old man presented to the emergency department of a local hospital with vomiting followed by hematemesis, chest pain, dyspnea, and fever. The chest radiography and computed tomographic (CT) scan revealed opacification of the right side of the chest. Two chest tubes were inserted with drainage of purulent fluid and regression of the clinical symptoms. A CT scan performed 2 days later revealed contrast-medium extravasation from the esophagus into the right hemithorax (Figure 1, A). The patient’s condition deteriorated 24 hours later; he showed fever and a leucocytosis count of 13,000/L. He was transferred to our institution 7 days after perforation, and a right thoracotomy was performed on the same day. At operation, a fibrin peel imprisoned the lung. After decortication, a complete reexpansion of the lung was obtained. However, a 3.5-cm transmural perforation of the esophagus was found, just below the azygos vein. The defect was debrided, and a T-tube was positioned. The chest was closed with multiple chest tubes in place. One drainage tube was placed in proximity to the T-tube, and the other tubes were placed in the pleural cavity and mediastinum (Figure 1, B). The patient was fed parenterally through a central venous line, and systemic antibiotics were administered. The postoperative course was unremarkable except for sporadic peaks of fever (up to 40°C) that stopped after suspension of antibiotics. The pleural and mediastinal drains were gradually removed. The T-tube (Figure 2, A) was removed in 2 steps 3 weeks later. First, we cut and removed the portion of the short branch of the T-tube through an esophagoscopy; the large branch was removed 2 days later. After repeated negative esophagrams (Figure 2, B), the patient resumed a regular diet and was discharged on postoperative day 38 without symptoms. Discussion Boerhaave Syndrome is the most lethal perforation of the gastrointestinal tract. 1 The combination of gastric acid and digestive enzymes causes mediastinitis and sepsis, which are fatal in most untreated cases. Although approximately 300 cases of Boerhaave Syndrome are reported in the literature, our case is interesting for 4 points summarized in the acronym “S.T.O.P.” (ie, “stop! pay attention”): Site, Time, Operation, Prognosis. Site: In 80% of cases, the rupture takes place in the lower left portion of the esophagus, 2 to 3 cm proximal to the gastroesophageal junction. In this case, the tear was localized in the middle right portion of the esophagus just below the azygos vein. Time: Diagnosis can be difficult, and prompt recognition is vital to ensure appropriate treatment. Although our patient presented with specific symptoms of Boerhaave Syndrome, he was first treated for empyema. The CT scan performed 7 days after perforation revealed contrast extravasation from the esophagus into the right hemithorax. The patient
Noel Lorenzo Villalba - One of the best experts on this subject based on the ideXlab platform.
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Abrupt Severe Chest Pain and Vomiting: Remember to Think of a Ruptured Oesophagus (Boerhaave Syndrome).
European journal of case reports in internal medicine, 2019Co-Authors: Deeba Ali, Arnaud Detroz, Yilmaz Gorur, Lionel Bosquee, Benoît Cardos, Carla Cobanoiu, Noel Lorenzo VillalbaAbstract:Boerhaave Syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. We describe a case of Boerhaave Syndrome diagnosed after the development of pneumomediastinum and cardiac arrest. Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures. LEARNING POINTS Boerhaave Syndrome is a diagnostic and therapeutic challenge, and rapid diagnosis and management are crucial. A thoraco-abdominal CT scan with oesophageal opacification is the gold standard investigation. A multidisciplinary and individualized approach is needed in the management of this condition. Keywords: Boerhaave Syndrome, pneumomediastinum, conservative, surgical, endoscopic INTRODUCTION Spontaneous perforation of the oesophagus, also referred to as Boerhaave Syndrome, is the longitudinal rupture of a previously unremarkable oesophagus[1]. This spontaneous perforation commonly results from the sudden increase of pressure within the oesophageal lumen caused by uncoordinated oesophageal motility during forceful vomiting. The diagnosis is difficult due to the incidental nature of the disorder and because its symptoms are often inconsistent and non-specific. Boerhaave Syndrome must be treated as a life-threatening emergency as it has a mortality rate of up to 40%[2].
Vivek Raj - One of the best experts on this subject based on the ideXlab platform.
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Do esophageal stents have a role in Boerhaave Syndrome? Case reports
Indian Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Sitendu Kumar Patel, Irfan Ali Shera, Vivek RajAbstract:Spontaneous esophageal rupture or Boerhaave Syndrome results from exponentially increased intra-esophageal pressure against closed glottis leading to transmural esophageal injury. There are no classical signs and symptoms for diagnosis. Vomiting, pain, and subcutaneous emphysema are the usual triad of presentation. It may also present as nonspecific chest discomfort to rapidly progressive subcutaneous emphysema. Covered endoscopic self-expanding and removable esophageal metal stents are rapidly emerging minimally invasive techniques to manage this condition with good success. We report two cases of Boerhaave Syndrome who were treated endoscopically with covered self-expanding metallic esophageal stents.
Jin Gu Lee - One of the best experts on this subject based on the ideXlab platform.
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Successful Management of Delayed Esophageal Rupture with T-Tube Drainage Using Video-Assisted Thoracoscopic Surgery
Korean Society for Thoracic and Cardiovascular Surgery, 2016Co-Authors: Chang Young Lee, Sungsoo Lee, Ha Eun Kim, Bong Jun Kim, Jin Gu LeeAbstract: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
Katarzyna Krupinskapaluszkiewicz - One of the best experts on this subject based on the ideXlab platform.
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cardiac arrest caused by tension pneumomediastinum in a Boerhaave Syndrome patient
The Annals of Thoracic Surgery, 2009Co-Authors: Piotr Paluszkiewicz, Jaroslaw Bartosinski, Katarzyna Rajewskadurda, Katarzyna KrupinskapaluszkiewiczAbstract:This report presents a 23-year-old man with esophageal perforation, tension pneumomediastinum, and subsequent cardiorespiratory arrest. Initial resuscitation by cervical and subxiphoid mediastinotomy was ineffective. Bedside decompression of the posterior mediastinum through the esophageal hiatus of the diaphragm resulted in immediate return of a normal sinus rhythm and noncompromised mechanical ventilation. The patient made a full recovery and was discharged on day 12. Transhiatal decompression of the posterior mediastinum can be recommended for the treatment of cardiorespiratory complications in patients with tension pneumomediastinum in whom the classic cervical and subxiphoid mediastinotomies are ineffective.