Boerhaave’s syndrome presenting with hematemesis: Case report

@#The clinical presentation of Boerhaave’s syndrome (BS), a rare condition of the gastrointestinal tract characterized by a spontaneous rupture of the esophagus most often caused by vomiting after excessive alcohol drinking or after consuming a large meal, mimics other less serious illnesses, often leading to a missed or delayed diagnosis. The Mackler triad, which is rare and pathognomonic of BS, includes lower thoracic or chest pain, subcutaneous emphysema, and vomiting. Diagnosis is made through computed tomography scan and esophageal contrast studies. Treatment of BS is geared towards control of mediastinitis and sepsis, and repair of the perforation or reestablishment of the continuity of the gastrointestinal tract. We report the case of a 46-year-old male with BS, who was initially managed with a conservative resection of the perforated esophagus 48 hours after the onset of symptoms. When the mediastinitis persisted we decided to do a subtotal esophagectomy and subsequent esophageal reconstruction.

An analysis of the new "three tubes" method in the treatment of spontaneous esophageal rupture / 中华内科杂志

To investigate the clinical efficacy, feasibility and safety of new "three tubes" method in the treatment of spontaneous esophageal rupture. A total of 22 patients with spontaneous esophageal rupture were retrospectively analyzed. Through the new "three tubes" method of treatment, patients achieved leak cured with reduced hospital stay, less medical expenses and early resumption of oral diet. The new "three tubes" method for spontaneous esophageal rupture has the advantages of easy handling, minimal invasion, few complication and exact curative effect.

Applieation of seven-step nursing method in patients with spontaneous esophageal rupture / 现代临床护理

Objective To summarize the experience of seven-step nursing method used in the care to patients with spontaneous esophageal rupture.Method Twenty patients with spontaneous esophageal rupture were treated with the seven-step nursing method. Results All patients were discharged after cure.The follow-ups found no complications of esophageal stenosis,reflux esophagitis and chronic empyema.Conclusion The seven-step nursing method used for caring the patients with spontaneous esophageal rupture can promote the recovery of patients and reduce their suffering.

Surgical treatment for esophageal perforation or rupture / 中华胸心血管外科杂志

Objective To review the experience of surgical therapy for 113 patients with esophageal perforation or rupture re- suiting from different causes.Methods The causes resulting in esophageal perforation or rupture were summarized and the outcome of conservative and operative therapy were compared.Meanwhile,the outcome and mortality of operative therapy within or beyond 24 hours were compared.Results Twenty-eight patients with esophageal perforation or rupture occurring in the neck were all cured sue- cessfully.As for 85 patients with esophageal perforation or rupture in the chest,the curative rate of operative therapy(83.0%)was greater than that of conservative therapy(68.7 %)(P

Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases

BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.

Endoscopic Findings in Boerhaave's Syndrome: Report of three cases / 대한소화기내시경학회지

Boerhaave's syndrome, which was first described by Herman Boerhave in 1724, is a spontaneous esophagcal rupture resulting from severe nausea and vomiting. It is a very rare disorder, frequently developed in the 4th to 6th decade of life, and affects males more commonly than females. A typical clinical triad of chest pain, fever, and subcutaneous emphysema was manifested in only 20-30% of cases involving an esophageal rupture and most patients complained of many nonspecific symptoms such as dyspnea and hematemesis. In cases of vomiting resulting from alcohol ingestion, gastrofiberscopy can be performed in hematemetic patients under the assumption of upper gastrointestinal bleeding in most cases of Boerhaave's syndrome. We report 3 patients of Boerhaave's syndrome who visited our hospital because of hematemesis. Their endoscopic findings were, 1) a large, deep oval-shaped laceration with a sharp margin on the distal esophagus 2) a cavitary lesion with internal multiple hematomas and/or necrotic debris, and 3) a formation of air bubbles in the hematoma relating to respiration.