Laparoscopic Treatment of Boerhaave’s Syndrome: a Case Report and Review of the Literature

Abstract

Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate. We report a case of perforation of the distal oesophagus. A 40-year-old male patient presented at the emergency department with a classic history of acute epigastric pain and dyspnoea after an episode of vomiting. On clinical examination we found a firm, tender abdomen and cervical subcutaneous emphysema. Boerhaave's syndrome was suspected on a clinical basis and was confirmed by thoraco-abdominal CT scan, showing an apparent pneumomediastinum and fluid at both lung bases. The patient underwent surgical repair of the distal oesophageal tear by laparoscopy. A mediastinal drain was left behind and a feeding gastrostomy was established. After initial improvement, the patient developed fever and dyspnoea. A thoracic CT scan revealed left-sided empyema. A thoracoscopic drainage of pus was performed and antibacterial and antifungal treatment was adapted. The patient recovered well and was discharged from the hospital 34 days after admission.

Hamman and Boerhaave syndromes – diagnostic dilemmas in a patient presenting with hyperemesis gravidarum: a case report

“…Symptoms of the syndrome are extremely varied with the literature describing a symptomatic 'triad of Macler' involving vomiting with subsequent retrosternal chest pain and subcutaneous emphysema. 11 Interestingly, although this patient had risk factors for oesophageal trauma and presented with the triad of Macler, she remained stable throughout her stay in hospital. Nevertheless, she was immediately referred to the surgical team for further imaging and investigation.…”

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

“…In contrast, laparoscopic repair for oesophageal perforation is less well described in the literature. Published case reports have reported successful management of oesophageal perforation via laparoscopy, with benefits that outweigh that of thoracoscopy or endoscopy [4,9,10,[18][19][20].…”

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery

“…While feeding, the jejunostomy may be opened via laparoscopic gastrostomy, but repair and drainage on a larger field in the oesophagus may be performed via thoracoscopy. [1314] Tissues such as the intercostal muscles, pleura, omentum and pericardium pedicle flaps may be used to strengthen the repair line in the perforated area, but discussions about their efficacy remain. [1516] The sternothyroid and sternocleidomastoid muscles may also be used in cervical oesophagus perforation.…”