PS01.038: Managing Post Stent Large Tef for Boerhaave Syndrome: A Therapeutic Challenge

Abstract

Background Stenting of Boerhaave syndrome is accepted as a modality of therapy but may not be successful at all times. We report a case of failed stenting, restenting and TEF due to stent. Methods This patient was managed at a different center and has undergone multiple procedures before. We have listed the procedures in chronological order. 24 FEB 2017: Endoscopy for acute retrosternal pain 28 FEB 2017: Left ICD for pyothorax 4 MARCH 2017: 15cm PTFE covered stent for large oesophageal rent at 28 cm 3 APRIL 2017: Stent removal 4 APRIL 2017: Check CT scan oesophago pleural fistula with 3mm rent on lelft lateral wall 8 APRIL 2017: Fistula closure with APC and fibrin sealant. 12 APRIL 2017: Fistula closure done with Thermal coagulation glue and covered SEMS. 27 MAY 2017: Stent removal and check ct showed supracarinal TEF admitting the scope. REFERED TO OUR UNIT AT THIS STAGE. Results Procedure done at our center: Right thoracotomy, layered fistula closure and vascularised intercostal muscle flap, subtotal esophagectomy, retrosternal gastric pullup, oesophago gastric anastamosis with feeding enteral access. Conclusion Post operative period was uneventful. Tracheostomy was done on 4th POD as there was drop in oxygen saturation. He improved gradually. Oral fuid started on day 7. Discharged on day 16. He is on regular followup.Tracheostomy and jejunostomy tubes removed. He was eating and speaking normally. This case is presented to high light the pertinent issues and limitations of SEMS placement for oeosphageal perforation. Diligent approach is to be followed in cases presenting with large diameter perforations. Caution should be exercised in SEMS exchange procedures when primary stenting has not produced optimal results. Surgery in select situations can be an optimal solution in these patients. Disclosure All authors have declared no conflicts of interest.