Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases.
- Author:
Dong Joon SHIN
1
;
Gi Young SUNG
;
Wook KIM
;
Hae Myung JEON
;
Yoon Bok LEE
;
Seoung Chul PARK
;
Min Kwang HONG
;
Moo Hyung SONG
;
Do Sang LEE
;
Il Young PARK
;
Jong Man WON
;
Nam Ik HAN
Author Information
1. Department of Surgery, College of Medicine, The Catholic University of Korea.
- Publication Type:Original Article
- Keywords:
Spontaneous esophageal rupture;
Boerhaave's syndrome
- MeSH:
Chest Pain;
Contrast Media;
Early Diagnosis;
Empyema;
Empyema, Pleural;
Esophagectomy;
Esophagostomy;
Esophagus*;
Female;
Gastrostomy;
Humans;
Internal Medicine;
Jejunostomy;
Korea;
Ligation;
Male;
Mediastinitis;
Middle Aged;
Mortality;
Pneumonia;
Prognosis;
Retrospective Studies;
Rupture;
Rupture, Spontaneous*;
Subcutaneous Emphysema;
Sutures;
Thorax;
Tomography, X-Ray Computed;
Vomiting
- From:Journal of the Korean Surgical Society
1999;57(2):210-216
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.
