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Case Reports
. 2014 May 21:2014:bcr2013200485.
doi: 10.1136/bcr-2013-200485.

Against all odds. Conservative management of Boerhaave's syndrome

Charles Anwuzia-Iwegbu  1 , Yasser Al Omran  2 , Amelia Heaford  3
Affiliations
Case Reports

Against all odds. Conservative management of Boerhaave's syndrome

Charles Anwuzia-Iwegbu et al. BMJ Case Rep. .

Abstract

Spontaneous oesophageal perforation or Boerhaave's syndrome is a life-threatening condition that usually requires early diagnosis and early surgical management. A 79-year-old man presented to the accident and emergency department with an ischaemic left big toe. He reported a 2-week history of worsening symptoms and a claudication distance in his left leg of 20-30 m. Three days post-revascularisation of the leg, the patient reported chest pain radiating to the back. CT angiography of the aorta indicated Boerhaave's syndrome. Following 35 days of conservative management in the intensive care unit and high dependency unit, the patient was stepped down to a surgical ward. A water-soluble contrast study demonstrated minimal leak through the perforated oesophagus. The patient was started on oral intake, which was well tolerated. This case highlights that conservative management may be appropriate.

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Figures

Figure 1
Figure 1
Water-soluble contrast study demonstrating the wall leak. Note the free mediastinal air along the oesophageal contour (arrow).
See this image and copyright information in PMC

References

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