Successful surgical strategy in a late case of Boerhaave's syndrome

Abstract

Boerhaave's syndrome refers to the spontaneous transmural rupture of the esophagus. Primary repair may be performed in patients who present within 24 h of perforation, and such cases have the best outcomes as most complications have not yet developed. However, the treatment of late perforations remains controversial. Various approaches and strategies to repair late perforations have been described in the literature, but there is no uniform approach. We present a case of Boerhaave's syndrome in which the patient underwent surgical repair 48 h after the acute event and was subsequently treated successfully. The initial approach included direct esophageal repair, a drainage series, and nutritional support via a feeding jejunostomy. Although the repair site was subsequently disrupted, the patient showed complete healing of the perforation after three weeks. We consider that our surgical treatment strategy is safe and technically feasible, and appears to be a promising alternative approach for the treatment of patients with late Boerhaave's perforation.

Keywords: Boerhaave’s perforation; Drainage; Nutritional support; Repair; Surgery.

Figure 1

A gastrografin swallow, showing extravasation of contrast in the left chest (arrow) (A), computed tomography of the chest with oral contrast, demonstrating a lower left esophageal tear with mediastinal leakage of oral contrast medium (arrow) and a left pleural effusion (B).

Figure 2

Intraoperative view showing the y-chest tube positioned near and parallel to the repaired esophagus (A) and custom-made y-chest tube (B).

Figure 3

Diagrammatic illustration of the drainage series.

Figure 4

Gastrografin swallow, showing free flow of contrast from the esophagus into the stomach without any leakage.