Quality-of-life study on four patients who underwent esophageal resection and delayed reconstruction for Boerhaave's syndrome

Abstract

Boerhaave's syndrome is the condition of spontaneous rupture of the esophagus as a consequence of the strain of emesis with or without predisposing esophageal disease. It is a condition with high mortality. We describe four patients who underwent a transthoracic esophagectomy to remove the rupture of the intrathoracic esophagus, closure of the esophageal gastric junction, fashioning of a feeding gastrostomy, and formation of a left cervical esophagostomy. Three patients underwent reconstruction with subcutaneous colon. We suggest that this method of management may be considered where primary repair is impossible in those patients too ill for prolonged reconstruction or as a salvage procedure where other methods have failed. The poor quality of life after esophagectomy is improved by reconstruction. Other surgical options include covering the repaired opening with a circumferential wrap of pleura, chest wall muscle, or omentum or closing the repair around a T-tube of large caliber. Esophageal exclusion using absorbable staples is another approach.

Surgical Management of Boerhaave's Syndrome in a Tertiary Oesophagogastric Centre

“…Delayed oesophageal reconstruction in these patients using either colonic or small bowel conduits is associated with an acceptable quality of life in the long term. 20 Transthoracic Transhiatal (n = 12) (n = 5)…”

A case of esophageal rupture caused by long-term exposure to vinegar and resolved by damage control strategies

“…Surgical treatment is preferable to the closure of the ruptured area with suture closure and intrathoracic drainage. In cases of the high risk of anastomosis due to high mediastinitis and poor general condition, the two-stage reconstruction technique after esophagectomy has been used in some cases [ 9 ].…”

Omental wrapping of esophageal rupture in combination with T-tube drainage

“…A number of treatment methods have been reported, including conservative treatments [3,21,22], metallic stent [23][24][25], esophagostomy [14], controlled fistula by T-tube [5][6][7], vascularized pedicle tissue flap using omentum [8], fundoplasty [10,11], primary closure [2,3], and esophagectomy [4]. The T-tube method was first reported by Abbott et al in 1970 [20].…”

“…Two hundred years later, Barrett reported its successful surgical repair [1]. Since then, several surgical procedures have been reported, such as primary closure [2,3], esophagectomy [4], T-tube drainage [5][6][7], a vascularized pedicled tissue flap with or without primary closure [8][9][10][11][12][13], and esophagostomy followed by secondary reconstruction [14].…”