Multidisciplinary damage control strategy for Boerhaave’s syndrome: A case report

Introduction

Boerhaave's syndrome is a rare clinical condition, characterized by the rupture of the oesophagus following a sudden increase in intraoesophageal pressure. It can occur in various regions of the oesophagus. Its rarity, coupled with the diversity of its possible presentations, makes the diagnosis more challenging and results in non-standardized treatment.

Case presentation

We report the case of a 71-year-old man who resorted to the emergency department with severe epigastric pain after vomiting. The patient's CT scan revealed an oesophageal rupture. A thoracoscopy was performed with pleural debridement and positioning of three pleural drainage. Endoscopic stenting was performed and a nutritional jejunostomy was prepared before admitting the patient to the Intensive Care Unit. The postoperative course was complicated by a para-oesophageal abscess and dislocation of the endoscopic stent. The patient was discharged home on the 46th day, and the endoscopic stents were successfully removed three months later.

Discussion

In the more extensive metanalysis we found, the majority of perforations were in the distal oesophagus, the initial therapeutic management consisted of surgery, followed by endoscopy, surgery and endoscopy together, and conservative treatment in 15 %. Most patients were admitted to ICU and the mortality reached 17 %. The time of diagnosis was crucially associated with clinical outcomes.

Conclusion

The choice of the most suitable approach should be tailored to the patient and should be guided by the time of diagnosis, perforation severity and patient medical condition at presentation, but the management of Boerhaave’s syndrome remains a challenge.