Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit Experience on Twelve Patients
Background: Boerhaave’s syndrome is a rare condition of spontaneous esophageal rupture with high mortality. Treatment is a challenging issue, diagnosis is difficult and early surgery is the most important prognostic factor.
Methods: This article presents a case series of 12 patients treated in our specialized unit between 2005 and 2013. Medical records and imaging reports from the specialized upper gastrointestinal surgery unit at a university hospital were reviewed.
Results: The median age was 59 years (37–83), the male/female ratio was 11/1 and half of the patients did not have any sign of pleural effusion at chest x‑ray. The diagnosis was made in 66 % of cases (8/12) by computed tomography. Nine patients were referred, and treatment delay was greater than 24 h in six patients. Ten patients were operated, and two were treated conservatively. A transabdominal approach was performed in five patients, with esophageal suture with gastric fundus patch being the most common procedure (5/10). Two patients underwent simple esophageal suture. One patient had mediastinal and pleural drainage with no other intervention. Two patients required bipolar esophageal exclusion. Three patients underwent reoperation for empyema, and one required esophagectomy. Mortality was 25 % (3/12): two operated patients and one who had been treated conservatively. The median intensive care unit stay was 15 days (5–61), and the median hospital stay was 33 days (5–97).
Conclusions: When combined with mediastinal debridement and pleural drainage, primary transhiatal esophageal repair for Boerhaave’s syndrome is associated with acceptable morbidity and mortality, regardless of treatment delay. Conservative treatment should be reserved for carefully selected patients.
Filippo Landi, Sandra Castro, Amaia Gantxegi, Paolo Bertoli, Nivardo Rodríguez, Jordi Pradell, Alejandro Solis, Manuel Armengol, European Surgery 4/2016