Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;91(7-8):1376-1384.
doi: 10.1111/ans.16501. Epub 2020 Dec 14.

Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature

Matthew G R Allaway  1 , Paul D Morris  1   2 , Jane-Louise B Sinclair  1 , Arthur J Richardson  1   2 , Emma S Johnston  1 , Michael J Hollands  1   2
Affiliations

Management of Boerhaave syndrome in Australasia: a retrospective case series and systematic review of the Australasian literature

Matthew G R Allaway et al. ANZ J Surg. 2021 Jul.

Abstract

Background: Boerhaave syndrome is a rare and life-threatening condition characterized by a spontaneous transmural tear of the oesophagus. There remains wide variation in the condition's management with non-operative management (NOM) and surgery being the two main treatment strategies. The aim was to review the presentation, management and outcomes for patients treated for Boerhaave syndrome at our institution and to compare these data with that previously reported within the Australasian literature.

Methods: A retrospective case series was performed for consecutive patients diagnosed with Boerhaave syndrome at our institution between January 2000 and January 2020. A systematic review of the Australasian literature was also performed.

Results: In case series, 15 patients were included (n = 2 NOM, n = 13 operative). The most common operative technique was primary repair with intercostal drainage via thoracotomy. Major complications occurred in 11 (73%) patients. Median Comprehensive Complication Index was 53.4 (interquartile range: 50). There was a significantly lower Comprehensive Complication Index associated with primary repair when compared to oesophageal resection (P = 0.01). There was one death, in the operative management group. Median length of hospital stay was 33 days (interquartile range: 58). In systematic review, 11 articles were included; four case series and seven case reports. From these, 23 patients met inclusion criteria. The majority of patients (83%) were managed operatively, with only four undergoing NOM. Seven patients died, representing an overall mortality rate of 30%.

Conclusions: We provide an updated overview of the management of Boerhaave syndrome within Australasia. Aggressive operative management is associated with reasonable outcomes.

Keywords: Australasia; Boerhaave syndrome; oesophageal rupture.

PubMed Disclaimer

References

    1. Korn O, Oñate JC, López R. Anatomy of the Boerhaave syndrome. Surgery 2007; 141: 222-8.
    1. Derbes VJ, Mitchell RE. 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.
    1. Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann. Thorac. Surg. 2004; 77: 1475-83.
    1. Mackler SA. Spontaneous rupture of the esophagus: an experimental and clinical study. Surg. Gynecol. Obstet. 1952; 95: 345-56.
    1. K-MC W, Schneider JI. High-risk chief complaints I: chest pain - the big three. Emerg. Med. Clin. North Am. 2009; 27: 685-712.

Publication types

Supplementary concepts

LinkOut - more resources