Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 4/2016

01.08.2016 | case report

Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit Experience on Twelve Patients

verfasst von: MD PhD Filippo Landi, MD Sandra Castro, MD Amaia Gantxegi, MD Paolo Bertoli, MD PhD Nivardo Rodríguez, MD Jordi Pradell, MD Alejandro Solis, MD PhD Manuel Armengol

Erschienen in: European Surgery | Ausgabe 4/2016

Einloggen, um Zugang zu erhalten
share
TEILEN

Abstract

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.
Literatur
1.
Zurück zum Zitat Mackler SA. Spontaneous rupture of the esophagus; an experimental and clinical study. Surg Gynecol Obstet. 1952;95:345–56. PubMed Mackler SA. Spontaneous rupture of the esophagus; an experimental and clinical study. Surg Gynecol Obstet. 1952;95:345–56. PubMed
3.
Zurück zum Zitat Nesbitt JC, Sawyers JL. Surgical management of esophageal perforation. Am Surg. 1987;53:183–91. PubMed Nesbitt JC, Sawyers JL. Surgical management of esophageal perforation. Am Surg. 1987;53:183–91. PubMed
4.
Zurück zum Zitat Abbas G, Schuchert MJ, Pettiford BL, et al. Contemporaneous management of esophageal perforation. Surgery. 2009;146:749–55. CrossRefPubMed Abbas G, Schuchert MJ, Pettiford BL, et al. Contemporaneous management of esophageal perforation. Surgery. 2009;146:749–55. CrossRefPubMed
5.
Zurück zum Zitat Griffin SM, Lamb PJ, Shenfine J, et al. Spontaneous rupture of the oesophagus. Br J Surg. 2008;95:1115–20. CrossRefPubMed Griffin SM, Lamb PJ, Shenfine J, et al. Spontaneous rupture of the oesophagus. Br J Surg. 2008;95:1115–20. CrossRefPubMed
6.
Zurück zum Zitat Shaker H, Elsayed H, Whittle I, et al. The influence of the ‘golden 24-h rule’ on the prognosis of oesophageal perforation in the modern era. Eur J Cardiothorac Surg. 2010;38:216–22. CrossRefPubMed Shaker H, Elsayed H, Whittle I, et al. The influence of the ‘golden 24-h rule’ on the prognosis of oesophageal perforation in the modern era. Eur J Cardiothorac Surg. 2010;38:216–22. CrossRefPubMed
7.
8.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Derbes VJ, Mitchell RE Jr.. Hermann Boerhaave’s Atrocis, nec descripti prius, morbi historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc. 1955;43:217–40. PubMedPubMedCentral Derbes VJ, Mitchell RE Jr.. Hermann Boerhaave’s Atrocis, nec descripti prius, morbi historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc. 1955;43:217–40. PubMedPubMedCentral
10.
Zurück zum Zitat Barrett NR. Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg. 1947;35:216–8. CrossRefPubMed Barrett NR. Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg. 1947;35:216–8. CrossRefPubMed
11.
Zurück zum Zitat de Schipper JP, Pull ter Gunne AF, Oostvogel HJ, et al. Spontaneous rupture of the oesophagus: Boerhaave’s syndrome in 2008. Literature review and treatment algorithm. Dig Surg. 2009;26:1–6. CrossRefPubMed de Schipper JP, Pull ter Gunne AF, Oostvogel HJ, et al. Spontaneous rupture of the oesophagus: Boerhaave’s syndrome in 2008. Literature review and treatment algorithm. Dig Surg. 2009;26:1–6. CrossRefPubMed
12.
Zurück zum Zitat Kollmar O. Boerhaave’s syndrome: primary repair vs. esophageal resection – case reports and meta-analysis of the literature. J Gastrointest Surg. 2003;7:726–34. CrossRefPubMed Kollmar O. Boerhaave’s syndrome: primary repair vs. esophageal resection – case reports and meta-analysis of the literature. J Gastrointest Surg. 2003;7:726–34. CrossRefPubMed
13.
Zurück zum Zitat Hingston CD, Saayman AG, Frost PJ, et al. Boerhaave’s syndrome – rapidly evolving pleural effusion; a radiographic clue. Minerva Anestesiol. 2010;76:865–7. PubMed Hingston CD, Saayman AG, Frost PJ, et al. Boerhaave’s syndrome – rapidly evolving pleural effusion; a radiographic clue. Minerva Anestesiol. 2010;76:865–7. PubMed
14.
Zurück zum Zitat Grillo HC, Wilkins EW. Esophageal repair following late diagnosis of intrathoracic perforation. Ann Thorac Surg. 1975;20:387–99. CrossRefPubMed Grillo HC, Wilkins EW. Esophageal repair following late diagnosis of intrathoracic perforation. Ann Thorac Surg. 1975;20:387–99. CrossRefPubMed
15.
Zurück zum Zitat Yamashita S, Takeno S, Moroga T, et al. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave’s syndrome). Hepatogastroenterology. 2012;59:745–6. PubMed Yamashita S, Takeno S, Moroga T, et al. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave’s syndrome). Hepatogastroenterology. 2012;59:745–6. PubMed
16.
Zurück zum Zitat Abbott OA, Mansour KA, Logan WD, et al. Atraumatic so-called “spontaneous” rupture of the esophagus. A review of 47 personal cases with comments on a new method of surgical therapy. J Thorac Cardiovasc Surg. 1970;59:67–83. PubMed Abbott OA, Mansour KA, Logan WD, et al. Atraumatic so-called “spontaneous” rupture of the esophagus. A review of 47 personal cases with comments on a new method of surgical therapy. J Thorac Cardiovasc Surg. 1970;59:67–83. PubMed
17.
Zurück zum Zitat Sulpice L, Dileon S, Rayar M, et al. Conservative surgical management of Boerhaave’s syndrome: experience of two tertiary referral centers. Int J Surg. 2013;11:64–7. CrossRefPubMed Sulpice L, Dileon S, Rayar M, et al. Conservative surgical management of Boerhaave’s syndrome: experience of two tertiary referral centers. Int J Surg. 2013;11:64–7. CrossRefPubMed
18.
Zurück zum Zitat Haveman JW, Nieuwenhuijs VB, Kobold JP, et al. Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome. Surg Endosc. 2011;25:2492–7. CrossRefPubMedPubMedCentral Haveman JW, Nieuwenhuijs VB, Kobold JP, et al. Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome. Surg Endosc. 2011;25:2492–7. CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Molena D, Mungo B, Stem M, et al. Novel combined VATS/laparoscopic approach for giant and complicated paraesophageal hernia repair: description of technique and early results. Surg Endosc. 2015;29:185–91. CrossRefPubMed Molena D, Mungo B, Stem M, et al. Novel combined VATS/laparoscopic approach for giant and complicated paraesophageal hernia repair: description of technique and early results. Surg Endosc. 2015;29:185–91. CrossRefPubMed
20.
Zurück zum Zitat Kimberley KL, Ganesh R, Anton CK. Laparoscopic repair of esophageal perforation due to Boerhaave syndrome. Surg Laparosc Endosc Perc Tech. 2011;21:e203–5. CrossRef Kimberley KL, Ganesh R, Anton CK. Laparoscopic repair of esophageal perforation due to Boerhaave syndrome. Surg Laparosc Endosc Perc Tech. 2011;21:e203–5. CrossRef
21.
Zurück zum Zitat Khan AZ, Forshaw MJ, Davies AR, et al. Transabdominal approach for management of Boerhaave’s syndrome. Am Surg. 2007;73:511–3. PubMed Khan AZ, Forshaw MJ, Davies AR, et al. Transabdominal approach for management of Boerhaave’s syndrome. Am Surg. 2007;73:511–3. PubMed
22.
Zurück zum Zitat Lawrence DR, Ohri SK, Moxon RE, et al. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg. 1999;67:818–20. CrossRefPubMed Lawrence DR, Ohri SK, Moxon RE, et al. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg. 1999;67:818–20. CrossRefPubMed
23.
Zurück zum Zitat Jougon J, Mc Bride T, Delcambre F, et al. Primary esophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg. 2004;25:475–9. CrossRefPubMed Jougon J, Mc Bride T, Delcambre F, et al. Primary esophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg. 2004;25:475–9. CrossRefPubMed
24.
Zurück zum Zitat Teh E, Edwards J, Duffy J, et al. Boerhaave’s syndrome: a review of management and outcome. Interact Cardiovasc Thorac Surg. 2007;6:640–3. CrossRefPubMed Teh E, Edwards J, Duffy J, et al. Boerhaave’s syndrome: a review of management and outcome. Interact Cardiovasc Thorac Surg. 2007;6:640–3. CrossRefPubMed
25.
Zurück zum Zitat Fischer A, Thomusch O, Benz S, et al. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006;81:467–72. CrossRefPubMed Fischer A, Thomusch O, Benz S, et al. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006;81:467–72. CrossRefPubMed
26.
Zurück zum Zitat Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastroint Endosc. 2011;73:890–9. CrossRef Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastroint Endosc. 2011;73:890–9. CrossRef
Metadaten
Titel
Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit Experience on Twelve Patients
verfasst von
MD PhD Filippo Landi
MD Sandra Castro
MD Amaia Gantxegi
MD Paolo Bertoli
MD PhD Nivardo Rodríguez
MD Jordi Pradell
MD Alejandro Solis
MD PhD Manuel Armengol
Publikationsdatum
01.08.2016
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2016
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-016-0392-6