Development of bilateral tension pneumothorax under anesthesia in a Boerhaave's syndrome patient: a case report

Abstract

A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.

A Rare Case of Boerhaave Syndrome Presenting with Right Tension Pneumothorax and Review of the Literature

“…Boerhaave syndrome has been recognized in the medical literature to present in unusual ways, however presentation with tension pneumothorax is exceedingly rare. There is only one previously reported case in North America, and 5 cases worldwide [10][11][12][13][14]. In contrast to our case, all of these cases reported history of preceding abdominal pain and vomiting, alerting the physicians to the possibility of esophageal rupture as the source of the pneumothorax.…”

Boerhaave syndrome: A rare cause of retrosternal pain

“…10 Ukoliko dođe do perforacije gornjeg torakalnog dijela nastaju pleuralni izljev ili hidropneumotoraks na desnoj strani. 10,17 Cervikalne rupture su najčešće benigne prirode obzirom da je širenje ka medijastinumu i retroezofagealnom prostoru usporeno i ograničeno. 10 Navedene komplikacije vode ka razvoju dehidracije, pneumomedijastinuma, pleuralnog empijema, masivnih pleuralnih izljeva, razvoju sepse i akutnog respiratornog distres sindroma, sindroma multiorganske disfunkcije, te letalnog ishoda.…”

Синдром Бурхаве В Практике Хирурга: Реалии И Перспективы

“…Неспецифичность симптомов обусловливает важность дифференциальной диагностики со спонтанным пневмотораксом, острым инфарктом миокарда, расслаивающей аневризмой аорты, панкреонекрозом и перфоративной гастродуоденальной язвой [35,40].…”

“…При невозможности ушивания разрыва в силу его протяженности или выраженных воспалительных изменений стенки «операциями отчаяния» являются резекционные вмешательства. Так, о резекции нижней трети пищевода с эзофагогастроанастомозом сообщает M. Oh (2016) [40]. J.S.…”