BACKGROUND The diagnosis of
Boerhaave's syndrome is often missed or delayed. This subsequently leads to a high mortality rate, which could be greatly reduced if treatment is instituted early, within 24 hours of perforation. Treatment ranges from
conservative management to operative intervention depending on the time of presentation and the patient's clinical condition. Endoscopic intervention in the form of over-the-scope
clip (OTSC) application is gaining popularity with very promising results. CASE REPORT A 43-year-old male was diagnosed with
Boerhaave's syndrome and treated initially by insertion of bilateral chest drainage, intravenous broad-spectrum
antibiotics, and
total parenteral nutrition. He was transferred to our facility 9 days later. Upper gastrointestinal endoscopy revealed a 1.5 cm deep longitudinal
ulcer involving the distal esophagus and extending to the Z-line. Due to the perforation site, a size 12 OTSC
clip was used. Application of a second
clip was needed to achieve complete closure of the perforation site. Contrast swallow was done 4 days later showed no leak. The patient was started on oral intake and was discharged home in good general condition after a
hospital stay of 16 days. CONCLUSIONS Delayed presentation of
Boerhaave's syndrome can be treated safely by an over-the-scope
clip. This endoscopic method hastens recovery and shortens the
hospital stay.