Laparoscopic Management of Boerhaave’s syndrome: a case report with an intraoperative video

Aref, Hager; Yunus, Tahir E.; Alhallaq, Obadah

doi:10.1186/s12893-019-0576-7

Cited by 13 publications

(20 citation statements)

References 23 publications

(22 reference statements)

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“…Two cases have required further thoracoscopic drainage and a pleural tap due to re-presentations with CT findings of a leftsided empyema and pleural effusion respectively. After which, symptoms resolved with targeted antibiotic and antifungal therapy based on pleural fluid analysis with no further re-interventions required [19,21]. Hence, we do suggest confirming that the pleural effusion if present pre-operatively is serous in nature prior to consideration for laparoscopic repair.…”

Section: Discussionmentioning

confidence: 52%

Trans-hiatal repair for Oesophageal and Junctional perforation: a case series

et al. 2020

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Background: Oesophageal perforation is a life-threatening condition that requires urgent intervention. Surgical repair is recommended within 24 h of onset to minimise mortality risk, traditionally via an open thoracotomy or a laparotomy. Primary oesophageal repair via a laparoscopic trans-hiatal approach has been seldomly reported due to concerns of inadequate eradication of soilage in the mediastinum and pleural space, as well as poor access and an increased operative time in an unwell population. Case presentation: We report a case series of 3 oesophageal and junctional perforations with varying presentations, demonstrating how the laparoscopic trans-hiatal approach can be used successfully to manage oesophageal perforations. Conclusions: Laparoscopic trans-hiatal repair is an attractive option for oesophageal and junctional perforations, in haemodynamically stable surgical candidates, in the absence of gross contamination of the thoracic cavity.

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Section: Discussionmentioning

confidence: 52%

Trans-hiatal repair for Oesophageal and Junctional perforation: a case series

et al. 2020

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“…Which is the best way to approach BS is still a matter of debate: actual guidelines for thoracic esophageal perforation suggest an individualized approach to primary repair the tear, while for what concern specifically esophageal spontaneous rupture, most of the available studies considered the thoracotomy/thoracoscopic approach as the way of choice [9,[17][18][19][20][21]. Anyway, there is not any specific guidelines for BS: some case reports suggest that laparoscopy may be just as safe and effective [12,13]; lastly, some authors also reported conservative or endoscopic treatment: nevertheless, these are just a few studies involving patients with less severe clinical picture, so further researches are needed to better understand their feasibility in more challenging conditions [5,7]. In this case series, we present our 5 years' experience: in all patients, we choose to approach laparoscopically the esophageal tear; when necessary, afterwards we performed a thoracic lavage through left thoracotomy.…”

Section: Discussionmentioning

confidence: 99%

“…As regards the type of surgical approach, thoracotomy is the most frequently chosen approach even if in literature there are several studies reporting transhiatal management as much as safe [11][12][13]. In our department, transabdominal approach is routinely adopted to treat BS.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

et al. 2020

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Background: Boerhaave's syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. Methods: Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. Results: Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions.

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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].…”

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].…”

Section: Discussionmentioning

confidence: 99%

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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Laparoscopic Management of Boerhaave’s syndrome: a case report with an intraoperative video

Cited by 13 publications

References 23 publications

Trans-hiatal repair for Oesophageal and Junctional perforation: a case series

Trans-hiatal repair for Oesophageal and Junctional perforation: a case series

Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave’s syndrome: an Italian single center case series study

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

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