Endoscopic repair of spontaneous esophageal rupture during gastroscopy

He, Feiyun; Dai, Mu-Gen; Zhou, Jing; He, Jiansheng; Ye, Bin

doi:10.1097/md.0000000000013422

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…Spontaneous oesophageal rupture, also known as Boerhaave syndrome (BS), is a life-threatening benign disease of the gastrointestinal tract [3] that typically results from a sudden increase in intraoesophageal pressure such as forceful retching or severe vomiting [4] and most frequently occurs in the left wall of the lower third of the oesophagus, a site that is anatomically vulnerable [5]. BS, to our knowledge, has been demonstrated in various patients, including those with gastrointestinal stenosis, Barrett's oesophagus, ileus, and frequent vomiting during continued chemotherapy or gastroscopy and after general anaesthesia [3]. However, in our case, the patient's esophageal wall tear was unusually secondary to oral magnesium sulfate administration, and second, most unique to our case, his rupture was located in the right wall of the distal oesophagus, which was in disagreement with the most frequent site of perforation reported [5].…”

Section: Discussionmentioning

confidence: 99%

“…This characteristic history is of great signi cance for the diagnosis of BS [3]. In addition, images including plain chest roentgenograms, oesophagograms, and CT scans also contribute to diagnosing BS [8].…”

Section: Discussionmentioning

confidence: 99%

“…Data from the literature indicate that the golden period for primary repair is the rst 24 hours of the event for oesophageal perforation when it can be associated with a 90% success rate [4]. The principles of treatment include removing the source of pollution, closing the breach, restoring the integrity of the oesophagus, full drainage, controlling the infection, strengthening nutritional support, improving the body and promoting wound healing [3,8]. The traditional management of BS has been prompt surgery [8].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Oesophageal Rupture of The Right Wall After Oral Administration of Sulfate Solution: An Unusual Case Report

Huang

et al. 2020

Preprint

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Background: Patients with gastrointestinal stenosis, Barrett's oesophagus, and vomiting during endoscopic preconditioning or after general anaesthesia may develop spontaneous oesophageal rupture in the literature. However, we found an unusual case in which oral sulfate solution triggered oesophageal perforation. Additionally, the oesophageal chasm uncommonly presented at the right wall, while most ruptures are located in the left wall of the oesophagus, and the unexplained and rapidly progressive right-sided pleural effusion in this patient could be associated with this entity. To the best of our knowledge, this is the first published case of oesophageal rupture of the right wall after oral administration of sulfate solution in the literature.Case presentation: For this patient, he suffered from acute onset of unbearable epigastric pain and compression pain in the right chest, with dyspnea, chest tightness and palpitation, after severe nausea and vomiting following oral administration of sulfate solution, and findings from imaging and gastroscopy eventually confirmed oesophageal rupture. Anti-infective treatments, pleural drainage, rehydration and total parenteral nutrition were administered immediately; subsequently, we used a total of seven titanium clips to close the oesophageal rupture under gastroscopic guidance. Eventually, he demonstrated good evolution after the operation and was discharged after recovery. Conclusions: This case emphasizes the importance of considering BS when dealing with patients with severe vomiting, acute chest pain, or dyspnea, especially after administration of sulfate solution for bowel cleansing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous Oesophageal Rupture of The Right Wall After Oral Administration of Sulfate Solution: An Unusual Case Report

Huang

et al. 2020

Preprint

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“…The high morbidity of the illness is also a result of a number of circumstances, including the difficulty in evaluating the esophagus and the peculiar organ blood supply. In the absence of treatment, Boerhaave's syndrome patients may only survive a few days [49][50][51]. The condition may show vague symptoms, or the traditional Mackler triad of vomiting, discomfort in the chest, and subcutaneous emphysema may be present.…”

Section: Esophageal Rupturementioning

confidence: 99%

ST-Segment Elevation in Conditions of Non-cardiovascular Origin Mimicking an Acute Myocardial Infarction: A Narrative Review

Khurana¹,

Ranjan²

2022

Cureus

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The most widespread presenting ailments among patients visiting the emergency department are chest pain and shortness of breath. These symptoms lead any doctor to a probable diagnosis of myocardial infarction (MI). Detailed patient history, testing of blood samples for cardiac biomarkers that are indicative of cardiovascular necrosis, ultrasound methods, electrocardiography, and coronary computed tomography (CT) could all be beneficial to support the diagnosis. Out of these, electrocardiography is the most important and commonly done investigation in the emergency departments for patients presenting with chest pain and shortness of breath. However, interpreting these patients' electrocardiograms (ECGs) may be a matter of concern and worry. T wave and ST-segment changes are often of interest in the early signs of myocardial ischemia. Despite its incredible sensitivity, ST-segment deviation (elevated or depressed) has a low specificity because it can be seen in a variety of other cardiac and non-cardiac diseases. When ST-segment anomalies are identified, clinicians must consider many additional characteristics (such as risk factors, symptoms, and anamnesis), as well as all other possible diagnoses.All of these scenarios of patients presenting in the emergency department with chest discomfort and shortness of breath showing ST-segment abnormalities can leave a healthcare professional wondering whether to start treatment for acute myocardial infarction, through either the administration of a fibrinolytic agent, exposing patients to both the benefits and risks of fibrinolysis, or invasive coronary angiography. An astute physician may be able to recognize fabricated differential diagnosis mimicking STsegment elevation myocardial infarction (STEMI) in some situations. Failure to recognize these imposters can result in inefficient resource utilization, which can expose patients to unjustified risk and increased rather than decreased death and morbidity. Since the danger of cerebral hemorrhage from blood thinners is significant, in patient-care scenarios, in order to rule out percutaneous coronary intervention (PCI), a thorough assessment of the ECG is essential to consider diseases other than acute myocardial infarction, especially the ones that are non-cardiac in origin. The goal of this narrative review is to give an overview of the significant disorders that are non-cardiac in origin that can mimic an ST-segment elevation myocardial infarction (STEMI).

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“…Dentro de las causas de la perforación esofágica se encuentran iatrogénicas, ingestión cáustica, traumatismo, dilataciones, escleroterapia o vómitos severos [1][2][3] . La perforación esofágica espontánea (PEE) es una forma rara de ruptura del grosor de la pared del esófago sano, de manera no traumática 3,4 , característico en pacientes de mediana edad, con obesidad, y alcohólicos con episodios violentos de náu-seas y vómitos. Siendo resultado de un rápido aumento de la presión intraesofágica, con obstrucción de la parte proximal del esófago 5 .…”

Section: Introductionunclassified