Laparoscopic treatment of Boerhaave's syndrome: a case report and review of the literature.

Abstract

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate. We report a case of perforation of the distal oesophagus. A 40-year-old male patient presented at the emergency department with a classic history of acute epigastric pain and dyspnoea after an episode of vomiting. On clinical examination we found a firm, tender abdomen and cervical subcutaneous emphysema. Boerhaave's syndrome was suspected on a clinical basis and was confirmed by thoraco-abdominal CT scan, showing an apparent pneumomediastinum and fluid at both lung bases. The patient underwent surgical repair of the distal oesophageal tear by laparoscopy. A mediastinal drain was left behind and a feeding gastrostomy was established. After initial improvement, the patient developed fever and dyspnoea. A thoracic CT scan revealed left-sided empyema. A thoracoscopic drainage of pus was performed and antibacterial and antifungal treatment was adapted. The patient recovered well and was discharged from the hospital 34 days after admission.

• Authors: C Toelen, L Hendrickx, R Van Hee
• Journal: Acta chirurgica Belgica (Acta Chir Belg) Vol. 107 Issue 4 Pg. 402-4 ( 2007) ISSN: 0001-5458 [Print] England
• PMID: 17966533 (Publication Type: Case Reports, Journal Article, Review)

Topics

• Acute Disease
• Adult
• Esophageal Diseases (surgery)
• Humans
• Laparoscopy (methods)
• Male
• Rupture, Spontaneous (surgery)
• Syndrome