RESUMO
INTRODUCTION: Boerhaave's syndrome is a rare condition involving spontaneous rupture of the oesophagus. The diagnosis is difficult and the prognosis depends on early diagnosis and treatment. CASE REPORT: We report a case of spontaneous rupture of the oesophagus in a 70-year-old woman where the diagnosis was delayed. Initial treatment comprised dual antibiotic therapy and feeding via a jejunostomy. Three months later, direct suture of the oesophagus was performed successfully. A routine pleural biopsy performed during the surgery revealed pleural tuberculosis. Antituberculous treatment was given for 6 months with good progress after 16 months follow up. CONCLUSION: Boerhaave's syndrome is a rare condition, the diagnosis of which remains difficult. The prognosis is related essentially to the speed of diagnosis. The treatment is always surgical within the framework of appropriate medical management (intensive care, antibiotic therapy). There should be a systematic search for associated pathology.
Assuntos
Empiema Pleural/etiologia , Infecções por Klebsiella/etiologia , Enfisema Mediastínico/etiologia , Tuberculose Pleural/complicações , Tuberculose Pleural/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Biópsia , Terapia Combinada , Diagnóstico Tardio , Diagnóstico Diferencial , Empiema Pleural/patologia , Empiema Pleural/terapia , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/patologia , Perfuração Esofágica/terapia , Feminino , Humanos , Infecções por Klebsiella/patologia , Infecções por Klebsiella/terapia , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/patologia , Doenças do Mediastino/terapia , Enfisema Mediastínico/patologia , Enfisema Mediastínico/terapia , Pleura/patologia , Recidiva , Ruptura Espontânea , Toracotomia , Tuberculose Pleural/patologia , Tuberculose Pleural/terapiaRESUMO
INTRODUCTION: Enlargement of the thymus following remission of a cancer treated by chemotherapy poses a problem of differential diagnosis between benign thymic hyperplasia and relapse of a mediastinal tumour. CASE REPORT: We report the case of a thymic tumour developing 6 months after chemotherapy for ovarian cancer in a woman of 31 years. Because of the risk of a mediastinal recurrence, the patient was submitted to thymectomy by mediastinotomy. Histopathological examination revealed benign thymic hyperplasia in reaction to the chemotherapy. The postoperative course was uneventful. CONCLUSION: Benign thymic hyperplasia may develop after chemotherapy. It is an inflammatory reaction that subsides after a few months. A multidisciplinary discussion to consider the possibility of benign hyperplasia may save the patient unnecessary surgery.
