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Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit Experience on Twelve Patients

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Abstract

Background

Boerhaave’s syndrome is a rare condition of spontaneous esophageal rupture with high mortality. Treatment is a challenging issue, diagnosis is difficult and early surgery is the most important prognostic factor.

Methods

This article presents a case series of 12 patients treated in our specialized unit between 2005 and 2013. Medical records and imaging reports from the specialized upper gastrointestinal surgery unit at a university hospital were reviewed.

Results

The median age was 59 years (37–83), the male/female ratio was 11/1 and half of the patients did not have any sign of pleural effusion at chest x‑ray. The diagnosis was made in 66 % of cases (8/12) by computed tomography. Nine patients were referred, and treatment delay was greater than 24 h in six patients. Ten patients were operated, and two were treated conservatively. A transabdominal approach was performed in five patients, with esophageal suture with gastric fundus patch being the most common procedure (5/10). Two patients underwent simple esophageal suture. One patient had mediastinal and pleural drainage with no other intervention. Two patients required bipolar esophageal exclusion. Three patients underwent reoperation for empyema, and one required esophagectomy. Mortality was 25 % (3/12): two operated patients and one who had been treated conservatively. The median intensive care unit stay was 15 days (5–61), and the median hospital stay was 33 days (5–97).

Conclusions

When combined with mediastinal debridement and pleural drainage, primary transhiatal esophageal repair for Boerhaave’s syndrome is associated with acceptable morbidity and mortality, regardless of treatment delay. Conservative treatment should be reserved for carefully selected patients.

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Acknowledgements

This study was reported as an oral presentation at the XXIII Spanish section meeting of the International Society for the Diseases of the Esophagus (ISDE), held on May 2–3 2013 in San Sebastian, Spain.

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Authors and Affiliations

  1. Esophago-Gastric Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario Vall d’Hebron, Universidad Autonoma de Barcelona, Paseo Vall d’ Hebron 119–129, 08035, Barcelona, Spain

    Filippo Landi MD PhD, Sandra Castro MD, Amaia Gantxegi MD, Nivardo Rodríguez MD PhD & Jordi Pradell MD

  2. Department of General and Digestive Surgery, Hospital Universitario Vall d’Hebron, Universidad Autonoma de Barcelona, UAB, Barcelona, Spain

    Filippo Landi MD PhD, Paolo Bertoli MD, Alejandro Solis MD & Manuel Armengol MD PhD

Authors
  1. Filippo Landi MD PhD
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  2. Sandra Castro MD
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  3. Amaia Gantxegi MD
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  4. Paolo Bertoli MD
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  5. Nivardo Rodríguez MD PhD
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  6. Jordi Pradell MD
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  7. Alejandro Solis MD
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  8. Manuel Armengol MD PhD
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Corresponding author

Correspondence to Filippo Landi MD PhD.

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Conflict of interest

F. Landi, S. Castro, A. Gantxegi, P. Bertoli, N. Rodríguez, J. Pradell, A. Solis and M. Armengol have no financial ties or conflict of interests to disclose.

Ethical standards

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Landi, F., Castro, S., Gantxegi, A. et al. Treatment of Boerhaave’s Syndrome: Specialized Esophago-Gastric Unit Experience on Twelve Patients. Eur Surg 48, 235–240 (2016). https://doi.org/10.1007/s10353-016-0392-6

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  • DOI: https://doi.org/10.1007/s10353-016-0392-6

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