Diagnostic challenge and surgical management of Boerhaave’s syndrome: a case series 

Abstract

Background Boerhaave’s syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. Case presentation Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. Conclusions We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

Presentation of Boerhaave’s syndrome as an upper-esophageal perforation associated with a right-sided pleural effusion: A case report

“…Although many cases of spontaneous esophageal rupture have been reported, the lack of specific symptoms of this condition continues to pose a challenge[ 7 ]. Mackler's triad comprising an acute presentation of retching or vomiting, lower chest pain, and surgical emphysema, is a clinical manifestation with relatively high specificity for the diagnosis of spontaneous esophageal rupture.…”

Spontaneous pneumomediastinum in a young adult female

“…Chest pain and subcutaneous emphysema are also found in Boerhaave's syndrome, which consists of esophageal rupture due to increased intraesophageal pressure, and lack of cricopharyngeal sphincter relaxation [12]. However, unlike spontaneous pneumomediastinum, in Boerhaave's syndrome these findings are usually accompanied by a history of vomiting (Mackler triad).…”

“…Dyspnea, cough, sore throat, dysphonia, dysphagia, palpitations, and neck pain may be present [13]. It is a rare and dangerous condition due to the extravasation of gastric contents into the mediastinum and pleura, leading to infection and death [12,14]. Chest X-ray findings include interposition of air between the heart and the diaphragm, thymus elevation by air, and subcutaneous emphysema [13,14].…”

“…Lucent streaks surrounding mediastinal structures; Subcutaneous emphysema can be found; Costophrenic opacity and pneumothorax can be associated [12,14].…”

“…Gas surrounding mediastinal structures, usually seen in posterior mediastinum and under diaphragm; Pleural effusion; Pneumothorax; Paraesophageal abscess can be found [12,14].…”