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Eremia IA, Anghel CA, Cofaru FA, Nica S. Early Presentation of Boerhaave Syndrome in the Emergency Department: A Case Report and Review of the Literature. Diagnostics (Basel) 2024; 14:1592. [PMID: 39125468 PMCID: PMC11311301 DOI: 10.3390/diagnostics14151592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the lower esophagus, emergency surgical intervention was performed, including esophageal suturing, mediastinal drainage, and jejunostomy for feeding. Postoperatively, the patient was transferred to the intensive care unit for advanced monitoring and support. The patient's condition improved favorably in the intensive care unit, allowing for extubation. Progress continued positively, and the patient was discharged 12 days postoperatively with a functional jejunostomy. At regular follow-ups, the patient's recovery remained favorable, and the jejunostomy was removed 30 days after the surgery. This case highlights the importance of rapid diagnosis and early surgical intervention in Boerhaave syndrome, demonstrating the successful management of a severe condition through a multidisciplinary effort.
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Affiliation(s)
- Irina-Anca Eremia
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
- Emergency Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Cătălin-Alexandru Anghel
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
| | | | - Silvia Nica
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
- Emergency Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
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2
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Tanaka T, Ikeuchi R, Hisamatsu K, Mizuno D, Koyanagi T, Morihiro T, Kurosaki T, Uno F, Wada S, Tanaka H, Tsugeno H, Ozaki S, Ishizaki M, Nishi H, Fujimoto N. Boerhaave syndrome presenting black pleural effusion: A case report. Respir Med Case Rep 2022; 40:101781. [DOI: 10.1016/j.rmcr.2022.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
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3
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Uchida S, Saito H, Kuriyama K, Yoshida T, Hara K, Sakai M, Sohda M, Saeki H, Shirabe K. A case of spontaneous esophageal submucosal hematoma. Clin J Gastroenterol 2022; 15:522-525. [PMID: 35195857 DOI: 10.1007/s12328-022-01608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
A 78-year-old man visited a nearby hospital owing to chest pain triggered by vomiting. As computed tomography revealed suspected esophageal perforation, he was referred to our hospital. Upper gastrointestinal endoscopy showed blood coagula extending from the middle intra-thoracic to the esophago-cardiac junction (ECJ), and it was diagnosed as an esophageal submucosal hematoma. Conservative therapy was initiated by fasting and discontinuing oral anticoagulants. The lesion was monitored by upper gastrointestinal endoscopy. On day 12 of the symptom appearance, the hematoma had completely disappeared and on day 22, the patient was discharged from the hospital. In most cases, esophageal submucosal hematoma has a favorable course with preservative treatment. Esophageal submucosal hematoma should be considered as one of the differential diagnoses for chest pain triggered by vomiting.
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Affiliation(s)
- Shintaro Uchida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideyuki Saito
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kengo Kuriyama
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tomonori Yoshida
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Keigo Hara
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Khan A, Tafader A, Shaikh R, Jacob J. A Rare Complication of Asthma: Retropharyngeal Emphysema, Subcutaneous Emphysema, and Pneumomediastinum. Cureus 2020; 12:e10524. [PMID: 33094065 PMCID: PMC7574819 DOI: 10.7759/cureus.10524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spontaneous pneumomediastinum (SPM) is a relatively uncommon occurrence. Although unlikely, asthma exacerbations can produce enough barotrauma to produce this complication. In cases of SPM, the gas has the opportunity to track between fascial planes, making its way to subcutaneous tissues, usually of the neck and chest, resulting in subcutaneous emphysema (SE). In anomalous situations, this gas can track its way into the retropharyngeal space. This presentation is usually self-limiting, requiring supportive therapy. Severe cases can lead to airway compromise warranting invasive supportive airway maneuvers. Retropharyngeal emphysema, SE, and pneumomediastinum have rarely been described together in the literature. This case provides awareness of these three complications of asthma, while highlighting the need for deliberate chest imaging, including radiograph and non-contrast CT, in patients with severe asthma exacerbations.
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Affiliation(s)
- Ahsum Khan
- Internal Medicine, University of Connecticut School of Medicine, Farmington, USA
| | | | - Rafae Shaikh
- Internal Medicine, UConn Health, Farmington, USA
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5
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Veltri A, Weindelmayer J, Alberti L, De Pasqual CA, Bencivenga M, Giacopuzzi S. Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave's syndrome: an Italian single center case series study. World J Emerg Surg 2020; 15:42. [PMID: 32611429 PMCID: PMC7329525 DOI: 10.1186/s13017-020-00322-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
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. Conclusions To our knowledge, this is the largest case series reporting laparoscopic management of BS. We show that laparoscopy is a safe and feasible approach associated with a shorter length of hospital stay when compared with clinical series in which thoracic approach had been chosen. Of note, laparoscopic management would be easily adopted by surgical centers treating benign gastro-esophageal junction entailing a proper management more widely.
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Affiliation(s)
- A Veltri
- General and Upper GI Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani, 1, 37126, Verona, Italy. .,Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy.
| | - J Weindelmayer
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - L Alberti
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - C A De Pasqual
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - M Bencivenga
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - S Giacopuzzi
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
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Schweigert M, Beattie R, Solymosi N, Booth K, Dubecz A, Muir A, Moskorz K, Stadlhuber RJ, Ofner D, McGuigan J, Stein HJ. Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome. Am Surg 2020; 79:634-40. [DOI: 10.1177/000313481307900627] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy.
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Affiliation(s)
- Michael Schweigert
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany; the
| | - Rory Beattie
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | | | - Karen Booth
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Attila Dubecz
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany; the
| | - Andrew Muir
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Kerstin Moskorz
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany; the
| | - Rudolf J. Stadlhuber
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany; the
| | - Dietmar Ofner
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Jim McGuigan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hubert J. Stein
- Department of General and Thoracic Surgery, Klinikum Nuremberg Nord, Nuremberg, Germany; the
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7
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Velasco Hernández DN, Horiuchi HR, Rivaletto LA, Farina F, Viscuso M. Boerhaave's syndrome with late presentation. Experience in an Argentine single center: Case series. Ann Med Surg (Lond) 2019; 45:59-61. [PMID: 31367374 PMCID: PMC6651841 DOI: 10.1016/j.amsu.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background In the year 1724, Hermann Boerhaave reported a case of a Dutch admiral who died due to spontaneous rupture of the esophagus following vomiting. The aim of this retrospective study is to analyze the therapeutic modality, morbidity and mortaliy of a group of patients with spontaneous esophageal rupture treated in our hospital. Methods Ten patients were treated from March 1990 to August 2016. Seven patients were males and three were females. The age range was, 52-72 years, with an average of 66.2 years. In four patients, the diagnosis and posterior treatment were performed within 24 h (Group I) and the remaining six patients after 24 h (Group II). Results The mean hospital stay was 36.6 days (range 17-62 days). The mortality rate was 50%, which was due to septic shock and the morbidity of patients who survived was 40% due to pneumonia in one case and fistula in another. Discussions This condition has a high mortality rate with a lethality that depends on the time between recognition of symptoms and proper surgical treatment.
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Affiliation(s)
| | - Héctor R Horiuchi
- University Hospital General San Martín, La Plata, Buenos Aires, Argentina
| | - Lucas A Rivaletto
- University Hospital General San Martín, La Plata, Buenos Aires, Argentina
| | - Fidelio Farina
- University Hospital General San Martín, La Plata, Buenos Aires, Argentina
| | - Matías Viscuso
- University Hospital General San Martín, La Plata, Buenos Aires, Argentina
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8
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Alnamlah M, Abdulkarim LS, AlFakhri L, Alali A. Spontaneous Pneumomediastinum in a Healthy Young Male: A Case Report from Riyadh, Saudi Arabia. Cureus 2019; 11:e4442. [PMID: 31245228 PMCID: PMC6559696 DOI: 10.7759/cureus.4442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumomediastinum is defined as the presence of air in the mediastinum. Trauma to the nearby organs can cause air to escape into surrounding tissues that may manifest clinically as severe chest pain, voice change, or shortness of breath. However, pneumomediastinum can present spontaneously in healthy individuals with no inciting factors in which case the condition is termed spontaneous pneumomediastinum (SPM). Pneumomediastinum can be challenging to manage due to the absence of clear guidelines for the diagnosis and management. We present the case of a 21-year-old with no previous medical history who presented with chest pain that was aggravated by speech and breath. The pain was of sudden onset preceded by smoking at 2:00 am. The patient was tachycardic, tachypnoeic with crepitation on palpation and a crunch sound (Hamman’s sign) on auscultation. The patient rated the pain as 5/10 on a 11-point numerical pain rating scale, which then evolved to 10/10. The patient did not have fever, loss of consciousness (LOC), diaphoresis, history of trauma, or previous similar presentation. There were no other associated symptoms. A chest X-ray (posteroanterior (PA) and lateral view) showed pneumomediastinum, but laboratory tests results were otherwise normal. The patient was observed in the emergency room overnight. He remained stable, his tachycardia settled, and there was no leukocytosis or desaturation; however, tachypnea was observed. His pain symptoms were treated with analgesia as needed and the patient was discharged home in a stable condition, to be followed on an outpatient basis. Spontaneous pneumomediastinum can be challenging to manage due to the lack of reliable incidence data as well as the absence of clear management guidelines. Further research will aid in understanding the true incidence of SPM in Saudi Arabia and help in establishing a consensual approach and treatment guidelines to deal with SPM in otherwise healthy individuals. To the best of our knowledge, this is the first case of SPM in a young male reported from a tertiary hospital in Riyadh, Saudi Arabia.
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Affiliation(s)
- Mohammed Alnamlah
- Emergency Medicine, College of Medicine at Alfaisal University, Riyadh, SAU
| | | | - Lama AlFakhri
- Miscellaneous, College of Medicine at Alfaisal University, Riyadh, SAU
| | - Abdulaziz Alali
- Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, SAU
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9
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Abstract
Well-timed diagnostics of a spontaneous nontraumatic rupture of esophagus or Boerhaave’s syndrome, presents great difficulties because of his rarity and a variety of clinical implications. Esophagus ruptures may feign various organs pathology [2] that most often demands differential diagnostics with a stomach ulcer perforation, acute myocardial infarction, pulmonary artery embolism, aortic dissection and pancreatitis [16, 17]. The treatment can include conservative and surgical tools, but still accompanied by high mortality (up to 35%) [7]; results largely defined by the time between the moment of a rupture and start of the treatment. In addition to the review, described the experience of successful treatment of a patient with Boerhaave’s syndrome in the light of the generalized today data of world medical literature on this problem.
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10
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He F, Dai M, Zhou J, He J, Ye B. Endoscopic repair of spontaneous esophageal rupture during gastroscopy: A CARE compliant case report. Medicine (Baltimore) 2018; 97:e13422. [PMID: 30508951 PMCID: PMC6283190 DOI: 10.1097/md.0000000000013422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy. PATIENT CONCERNS A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. During the gastroscopy, he vomited severely, which was followed by severe left chest pain radiating into the back and upper abdomen. The diagnosis was made by computed tomography (CT) scan without delay. Enhanced CT showed extensive mediastinal emphysema, a small amount of left pleural effusion, and a 6 cm tear was confirmed in the lower esophagus posteriorly. DIAGNOSES The patient was diagnosed with an intrathoracic rupture type of spontaneous esophageal rupture. INTERVENTIONS The patient received endoscopic suturing techniques under endotracheal intubation, titanium clip clamping, and over the scope clip (OTSC) sealing. OUTCOMES The procedure was smooth and the patient recovered well after operation. LESSONS During gastroscopy, the risk of esophageal rupture should be considered due to sudden pain caused by severe nausea and vomiting. Esophageal rupture can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
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Affiliation(s)
- Feiyun He
- Department of Gastroenterology, Lishui Chinese medicine hospital
| | - Mugen Dai
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University
| | - Jiwang Zhou
- Department of Gastroenterology, Lishui Chinese medicine hospital
| | - Jiansheng He
- Department of Anorectal surgery, Lishui Chinese medicine hospital, Lishui, Zhejiang Province, China
| | - Bin Ye
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University
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11
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Tanaka H, Uemura N, Nishikawa D, Oguri K, Abe T, Higaki E, Hosoi T, An B, Hasegawa Y, Shimizu Y. Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report. Surg Case Rep 2018; 4:54. [PMID: 29884971 PMCID: PMC5993691 DOI: 10.1186/s40792-018-0462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome. To the best of our knowledge, this is the first report of a patient with esophageal rupture occurring during CRT for hypopharyngeal cancer with stenosis. Case presentation A 66-year-old man with a sore throat was referred to our hospital. He was found to have stage IVA hypopharyngeal cancer, cT2N2bM0, and underwent radical concurrent CRT consisting of weekly cisplatin (30 mg/m2) and radiation (70 Gy/35fr), for larynx preservation. On day 27 of treatment, he vomited, which was followed by severe left chest pain radiating to the back and the upper abdomen. Enhanced computed tomography (CT) revealed extensive mediastinal emphysema and a small amount of left pleural effusion. Esophagography revealed extravasation into the left thoracic cavity, and the patient was diagnosed with an intrathoracic rupture type of Boerhaave syndrome. He underwent emergency left thoracotomy 21 h after the onset. The ruptured esophageal wall was primarily repaired by closure with two-layer suturing and covered by a pedicled omentum. A jejunostomy tube was placed for postoperative enteral nutrition. On postoperative day (POD) 16, the patient was transferred to head and neck surgery to finish CRT and was discharged on POD 56. He has survived without relapse for 11 months after surgery. Conclusion Patients with head and neck cancer are at risk for developing Boerhaave syndrome during CRT. In addition, since such patients often are in poor overall condition because of immunosuppression and protracted wound healing, Boerhaave syndrome can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.
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Affiliation(s)
- Hideharu Tanaka
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Norihisa Uemura
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Keisuke Oguri
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Byonggu An
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
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12
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Smyth AR, Wastell C. Spontaneous Rupture of the Oesophagus (Boerhaave's Syndrome): Delayed Diagnosis and Successful Conservative Management. J R Soc Med 2018; 82:498. [PMID: 2506347 PMCID: PMC1292261 DOI: 10.1177/014107688908200818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A R Smyth
- Professorial Surgical Unit, St Stephen's Hospital, London
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13
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Do esophageal stents have a role in Boerhaave syndrome? Case reports. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Felmly LM, Kwon H, Denlinger CE, Klapper JA. Esophageal Perforation: A Common Clinical Problem with Many Different Management Options. Am Surg 2017. [DOI: 10.1177/000313481708300846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Esophageal perforation is a complex clinical entity that has multiple etiologies and variability in presentation, making it challenging to diagnose and treat. The mortality of esophageal perforation has improved because therapies have evolved. Whereas primary repair is the standard of care, multiple treatments may be employed successfully. We retrospectively reviewed all cases of suspected or confirmed esophageal perforation that were admitted to the thoracic surgery service at our institution between January 2011 and June 2016. We reviewed the charts of 61 patients. Twenty-three underwent primary repair, 13 underwent stent placement, 12 underwent drainage, 12 underwent medical management, and one underwent exclusion and diversion. All patients were included in the final analysis except the singular patient who underwent diversion. Overall mortality was 4.9 per cent. None of the studied variables were found to be associated with mortality (P > 0.05). Factors associated with choice of treatment were age (P < 0.0005), Charlson Index (P = 0.032), etiology (P < 0.0005), and location (P = 0.005). The application of different management options is based on a thorough understanding time course, patient anatomy, severity of presentation, and underlying disease process.
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Affiliation(s)
- Lloyd M. Felmly
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Hyejin Kwon
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Chadrick E. Denlinger
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jacob A. Klapper
- Division of Cardiothoracic Surgery, Duke University, Durham, North Carolina
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Abstract
OPINION STATEMENT Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support. Endoscopic options include clips, both through the scope (TTS) and over the scope (OTS), stent placement, vacuum therapy, tissue adhesive, and endoscopic suturing techniques. Theoretically, all of these can be used alone or with a multimodality approach. Endoscopic therapy should be combined with medical therapy but also with percutaneous drainage of collections, where present. There is robust evidence suggesting that this change of therapeutic paradigm in the form of endoscopic therapy is associated with improved outcome, better quality of life, and shortened length of hospital stay. Moreover, recent European guidelines on endoscopic management of iatrogenic perforation have strengthened and to some degree regulated and redefined the role of endoscopy in the management of conditions where there is a breach in the continuity of the GI wall. Certainly, due to the complexity of these conditions and the variety of available treatment options, a multidisciplinary approach is strongly recommended, with close clinical monitoring (by endoscopists, surgeons, and intensive care physicians) and special attention to signs of sepsis, which can lead to the need for urgent surgical management. This review article will critically discuss the literature regarding endoscopic modalities for esophageal leak and perforation management and attempt to place them in perspective for the physician.
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Oh MK, Jeon WJ, Cho SY, Kwon YD, Kim KH. Development of bilateral tension pneumothorax under anesthesia in a Boerhaave's syndrome patient: a case report. Korean J Anesthesiol 2016; 69:175-80. [PMID: 27066209 PMCID: PMC4823415 DOI: 10.4097/kjae.2016.69.2.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 02/03/2015] [Accepted: 02/16/2015] [Indexed: 11/10/2022] Open
Abstract
A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.
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Affiliation(s)
- Mi Kyung Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sang Yun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Yong Deok Kwon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Kyoung Hun Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
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17
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Saito S, Hosoya Y, Kurashina K, Matsumoto S, Kanamaru R, Ui T, Haruta H, Kitayama J, Lefor AK, Sata N. Boerhaave's syndrome in a patient with an upside down stomach: A case report. Int J Surg Case Rep 2015; 19:51-4. [PMID: 26710329 PMCID: PMC4756090 DOI: 10.1016/j.ijscr.2015.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Spontaneous esophageal perforation, or Boerhaave's syndrome, is a life-threating condition which usually requires emergent surgery. An upside down stomach is defined as a gastric volvulus in a huge supradiaphragmatic sac. In general, this condition can result in ischemia and perforation of the stomach. This is the first report of a patient with Boerhaave's syndrome and an upside down stomach. CASE PRESENTATION A 79-year-old woman presented with sudden epigastric pain following hematemesis. Evaluation of the patient showed both an esophageal perforation and an upside down stomach. Surgical drainage and irrigation of the mediastinum and pleural cavities were undertaken emergently. Due to the concurrent gastric volvulus, a gastrostomy was placed to fix and decompress the stomach. The patient had an uneventful hospital course and was discharged. DISCUSSION AND CONCLUSION Boerhaave's syndrome is a rare but severe complication caused by excessive vomiting, due to a sudden elevation in intraluminal esophageal pressure resulting in esophageal perforation. Acute gastric volvulus can result in ischemia and perforation of the stomach, but has not previously been reported with esophageal perforation. The most likely mechanism associating an upside down stomach with Boerhaave's syndrome is acute gastric outlet obstruction resulting in vomiting, and subsequent esophageal perforation. Perforation of the esophagus as well as perforation of the stomach must be considered in patients with an upside down stomach although both upside down stomach and Boerhaave's syndrome are rare clinical entities.
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Affiliation(s)
- Shin Saito
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Yoshinori Hosoya
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | | | - Shiro Matsumoto
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Rihito Kanamaru
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Takashi Ui
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Hidenori Haruta
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Joji Kitayama
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan.
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18
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Anderson RE, Wilcox S, Miller ES. A Rare but Lethal Cause of Chest Pain. J Emerg Med 2015; 49:698-702. [PMID: 26281817 DOI: 10.1016/j.jemermed.2015.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/01/2015] [Indexed: 11/19/2022]
Affiliation(s)
- R Eleanor Anderson
- Department of Emergency Medicine, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Susan Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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19
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Rassameehiran S, Klomjit S, Nugent K. Right-sided hydropneumothorax as a presenting symptom of Boerhaave's syndrome (spontaneous esophageal rupture). Proc AMIA Symp 2015; 28:344-6. [PMID: 26130884 DOI: 10.1080/08998280.2015.11929269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Boerhaave's syndrome, or spontaneous esophageal rupture, is a rare condition that classically presents with Mackler's triad of vomiting, subcutaneous emphysema, and severe sudden onset of chest pain and requires immediate medical attention. Approximately 90% of the perforations occur at the left lateral aspect of the distal esophagus, causing a left-sided pleural effusion. Less than 10% of patients have bilateral effusions, and few patients have a right-sided pleural effusion only. We present the case of a 59-year-old man with spontaneous esophageal rupture. His clinical presentation is of interest since he had no inciting event for spontaneous esophageal rupture and had a delayed presentation with a right-sided hydropneumothorax.
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Affiliation(s)
- Supannee Rassameehiran
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Saranapoom Klomjit
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Science Center, Lubbock, Texas
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20
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Londono R, Badylak SF. Regenerative Medicine Strategies for Esophageal Repair. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:393-410. [PMID: 25813694 DOI: 10.1089/ten.teb.2015.0014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.
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Affiliation(s)
- Ricardo Londono
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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21
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Chest Pain After Vomiting. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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van der Weg G, Wikkeling M, van Leeuwen M, Ter Avest E. A rare case of oesophageal rupture: Boerhaave's syndrome. Int J Emerg Med 2014; 7:27. [PMID: 25364474 PMCID: PMC4215748 DOI: 10.1186/s12245-014-0027-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
A 70-year-old patient was referred to our emergency department with severe retrosternal pain after forceful vomiting. Computed tomography (CT) scan revealed a left-sided oesophageal rupture with accompanying pneumomediastinum and bilateral pleural effusions. Conservative treatment with cessation of oral intake, intravenous broad-spectrum antibiotics, parenteral fluids and nutrition and left sided tube thoracostomy was initiated initially. After 5 days, however, the patient deteriorated. Follow-up CT scan demonstrated a mediastinal fluid collection as well as loculated pleural empyema. Open thoracotomy with mediastinal debridement and pleural drainage was performed, after which he made a slow but full recovery. Spontaneous oesophageal rupture due to an abrupt rise in intraluminal pressure caused by vomiting is also known as Boerhaave's syndrome. It is a rare but potentially life-threatening condition. Many patients present with atypical symptoms, and therefore, physicians should have a high index of suspicion in any patient presenting with vomiting and retrosternal pain. When Boerhaave's syndrome is suspected, a CT scan of the thorax and upper abdomen should be performed since treatment depends on clinical and radiological findings. Conservative management (cessation of oral intake, nasogastric decompression, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum antibiotics and proton pump inhibitors and tube thoracostomies) may only be considered in patients with a contained rupture without systematic symptoms of infection. In these patients, endoscopic bridging of the tear with a self-expandable stent is also an option. Primary surgical repair (either by thoracotomy or by video assisted thoracoscopy (VATS)) should be considered when patients present with sepsis and/or large non-contained leaks or with severe mediastinal decontamination.
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Affiliation(s)
- Gerben van der Weg
- Department of Emergency Medicine, Medical Centre Leeuwarden, Henry Dunantweg 2, Leeuwarden 8934, BR, the Netherlands
| | - Marald Wikkeling
- Department of Surgery, Nij Smellinghe Hospital, Drachten 9202, NN, the Netherlands
| | - Maarten van Leeuwen
- Department of Radiology, Nij Smellinghe Hospital, Drachten 9202, NN, the Netherlands
| | - Ewoud Ter Avest
- Department of Emergency Medicine, Medical Centre Leeuwarden, Henry Dunantweg 2, Leeuwarden 8934, BR, the Netherlands
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23
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Bautista A, Heine M, van Berkel V, Kelly-Frasher L, Remmel K, Akca O. Right-Sided Pleural Effusion in a Critically Ill Stroke Patient. J Investig Med High Impact Case Rep 2014; 2:2324709614523258. [PMID: 26425594 PMCID: PMC4528863 DOI: 10.1177/2324709614523258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pleural fluid collections are common in those critically ill. We report the case of a left middle cerebral artery stroke patient who developed respiratory distress and required intubation and mechanical ventilation. Although the patient's clinical status and oxygenation improved, there was persistence of right-sided opacity in the chest radiograph. Further workup proved a right-sided pleural effusion, which was drained and managed. Following extubation, a swallow study was ordered, which led to a fluoroscopic examination that demonstrated esophageal perforation. Thoracic surgery was consulted and did a primary repair of perforation and noted non-small cell carcinoma on the perforated site.
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Affiliation(s)
| | | | | | | | | | - Ozan Akca
- University of Louisville, Louisville, KY, USA
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24
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Lee W, Siau K, Singh G. Boerhaave's syndrome presenting as an upper gastrointestinal bleed. BMJ Case Rep 2013; 2013:bcr-2013-201267. [PMID: 24293537 DOI: 10.1136/bcr-2013-201267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 64-year-old man without any significant medical history presented to accident and emergency department with haematemesis and melaena, quite similar to an upper gastrointestinal bleed. However, the unexplained left-sided neck pain with a history of overnight vomiting prompted further imaging. Air was visible in the soft tissues on a lateral X-ray of the neck, which led to a CT scan and this showed a proximal-mid oesophageal rupture. The patient was stabilised and transferred to a cardiothoracic unit for observation. An inpatient endoscopy did not detect a perforation and the patient was discharged 5 days later without any further complications. This case report highlights how a high oesophageal rupture can mimic an upper gastrointestinal bleed and also the need for further imaging when there is an incongruent history, so that appropriate care is provided to minimise mortality.
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Affiliation(s)
- William Lee
- Department of Gastroenterology, Bassetlaw Hospital, Worksop, UK
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25
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Schweigert M, Dubecz A, Solymosi N, Ofner D, Stein HJ. Times and Trends in the Treatment of Spontaneous Perforation of the Esophagus: From Herman Boerhaave to the Present Age. Am Surg 2013. [DOI: 10.1177/000313481307900928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spontaneous rupture of the esophagus is a rare devastating condition, which was first described by Herman Boerhaave in 1724. Only a handful of cases were recorded during the 18th and 19th centuries. Diagnosis was usually obtained on autopsy. Only in 1914 Irving Walker achieved the first antemortem diagnosis of spontaneous rupture of the esophagus. The dawn of thoracic surgery during the first decades of the 20th century opened up the way for operative cure. More than 200 years after Boerhaave's initial report, Barrett as well as Clagett and Olsen independently accomplished the first successful surgical treatment by primary repair of the esophageal lesion in 1947. Since those pioneer days, various suggestions for proper treatment have been made ranging from conservative, nonoperative means to extended procedures such as esophagectomy. Invention of minimally invasive surgery and endoscopic measures has further broadened the spectrum of available therapeutic options. The aim of this history article is to outline the development of diagnosis and management of spontaneous rupture of the esophagus from the age of Herman Boerhaave to the present times.
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Affiliation(s)
- Michael Schweigert
- Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany; the
| | - Attila Dubecz
- Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany; the
| | - Norbert Solymosi
- Faculty of Veterinary Science, Szent István University, Budapest, Hungary
| | - Dietmar Ofner
- Department of Surgery, Salzburger Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria
| | - Hubert J Stein
- Department of General and Thoracic Surgery, Klinikum Nuernberg Nord, Nuernberg, Germany; the
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26
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Boerhaave's Syndrome: Still a Diagnostic and Therapeutic Challenge in the 21st Century. Case Rep Crit Care 2013; 2013:161286. [PMID: 24829816 PMCID: PMC4010036 DOI: 10.1155/2013/161286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 05/15/2013] [Indexed: 12/15/2022] Open
Abstract
Boerhaave's syndrome is a rare but potentially fatal condition characterised by a transmural tear of the distal oesophagus induced by a sudden increase in pressure. Diagnosis is challenging as the classic triad of vomiting, abdominal or chest pain, and subcutaneous emphysema is absent in many patients. Management is multidisciplinary and relies on rapid, distinct, and repeated imaging. Treatment has not been standardised and may be conservative, endoscopic, or surgical. We present a typical case which illustrates possible diagnostic pitfalls and the therapeutic conundrum surrounding management of the syndrome. Based on time of presentation and eventual presence of sepsis, a therapeutic algorithm is proposed.
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27
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Venø S, Eckardt J. Boerhaave's syndrome and tension pneumothorax secondary to Norovirus induced forceful emesis. J Thorac Dis 2013; 5:E38-40. [PMID: 23585955 DOI: 10.3978/j.issn.2072-1439.2012.07.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/10/2012] [Indexed: 11/14/2022]
Abstract
Boerhaave's syndrome or spontaneous esophageal perforation is a rare condition, with high mortality. We describe a case of Boerhaave's syndrome presenting with tension pneumothorax. The patient was infected with Norovirus and developed Boerhaave's syndrome, initially thought to be gastroenteritis but later developing with tension pneumothorax, and mediastinitis caused by esophageal perforation. The patient was treated with thoracotomy with primary suture and oesophageal stent placement. He had a long period of recovery and was discharged after 98 days. Boerhaaves syndrome is often delayed and must be considered in any patient with respiratory symptoms and a recent history of vomiting.
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Affiliation(s)
- Søren Venø
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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30
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Gupta RK, Sah PL, Sah S, Sapkota S. Atypical presentation of Boerhaave's syndrome. BMJ Case Rep 2012; 2012:bcr-2012-006368. [PMID: 22783012 DOI: 10.1136/bcr-2012-006368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Boerhaave's syndrome is the rare and often fatal condition of spontaneous oesophageal rupture. When present with atypical symptoms, diagnosis is frequently late, which contributes to the high morbidity and mortality. The authors describe a unique case of a 50-year-old man presented with atypical Boerhaave's syndrome, in which the diagnosis was made several days following presentation by observing a large pleural effusion that had evolved rapidly on chest radiographs. He was managed without thoracotomy. Although survival has been reported with non-operative management of contained oesophageal perforations, to our knowledge, this is the rare case report of surviving Boerhaave's syndrome with free pleural rupture, without thoracotomy.
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Affiliation(s)
- Rakesh Kumar Gupta
- Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal.
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31
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Godinho M, Wiezel EHB, Marchi E, Módena SF, Paula RAD. [Spontaneous rupture of the esophagus: Boerhaave's syndrome]. Rev Col Bras Cir 2012; 39:83-4. [PMID: 22481713 DOI: 10.1590/s0100-69912012000100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 05/08/2007] [Indexed: 01/23/2023] Open
Abstract
Boerhaave's syndrome, the spontaneous rupture of the esophagus, is associated with a 35% death rate. Perforated esophagus is a surgical emergency; it is the most serious, and frequently the most rapidly lethal, perforation of the gastro-intestinal tract. Three cases of Boerhaave's syndrome are presented, with their variants and resolutions. Treatment and outcome are largely determined by the time of presentation. We reviewed our experience with esophageal perforations to determine the overall mortality and whether the time of presentation should influence management strategy.
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Affiliation(s)
- Maurício Godinho
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brazil.
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32
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Cathcart MP, Thompson H, Sutton DGM. Spontaneous oesophageal perforation secondary to idiopathic muscular hypertrophy of the oesophagus. EQUINE VET EDUC 2012. [DOI: 10.1111/j.2042-3292.2011.00353.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Habchi K, Blatt A, Schmutz T, Hoffmann M, Braun F. Syndrome de Boerhaave. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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34
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Emmanouilidis N, Jäger MD, Winkler M, Klempnauer J. Boerhaave syndrome as a complication of colonoscopy preparation: a case report. J Med Case Rep 2011; 5:544. [PMID: 22054124 PMCID: PMC3220652 DOI: 10.1186/1752-1947-5-544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 11/05/2011] [Indexed: 11/22/2022] Open
Abstract
Introduction Colonoscopy is one of the most frequently performed elective and invasive diagnostic interventions. For every colonoscopy, complete colon preparation is mandatory to provide the best possible endoluminal visibility; for example, the patient has to drink a great volume of a non-resorbable solution to flush out all feces. Despite the known possible nauseating side effects of colonoscopy preparation and despite the knowledge that excessive vomiting can cause rupture of the distal esophagus (Boerhaave syndrome), which is a rare but severe complication with high morbidity and mortality, it is not yet a standard procedure to provide a patient with an anti-emetic medication during a colon preparation process. This is the first report of Boerhaave syndrome induced by colonoscopy preparation, and this case strongly suggests that the prospect of being at risk of a severe complication connected with an elective colonoscopy justifies a non-invasive, inexpensive yet effective precaution such as an anti-emetic co-medication during the colonoscopy preparation process. Case presentation A 73-year-old Caucasian woman was scheduled to undergo elective colonoscopy. For the colonoscopy preparation at home she received commercially available bags containing soluble polyethylene glycol powder. No anti-emetic medication was prescribed. After drinking the prepared solution she had to vomit excessively and experienced a sudden and intense pain in her back. An immediate computed tomography (CT) scan revealed a rupture of the distal esophagus (Boerhaave syndrome). After initial conservative treatment by endoluminal sponge vacuum therapy, she was taken to the operating theatre and the longitudinal esophageal rupture was closed by direct suture and gastric fundoplication (Nissen procedure). She recovered completely and was discharged three weeks after the initial event. Conclusions To the best of our knowledge, this is the first report of a case of Boerhaave syndrome as a complication of excessive vomiting caused by colonoscopy preparation. The case suggests that patients who are prepared for a colonoscopy by drinking large volumes of fluid should routinely receive an anti-emetic medication during the preparation process, especially when they have a tendency to nausea and vomiting.
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Affiliation(s)
- Nikos Emmanouilidis
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl Neuberg Strasse 1, D-30625 Germany.
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35
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Holdsworth G, Clarke R. CT heads diagnosing chest pathology? Whatever next? Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shinozuka E, Nomura T, Miyashita M, Makino H, Okawa K, Hagiwara N, Shigehara K, Akagi I, Shioda Y, Uchida E. Successful treatment of a spontaneous esophageal rupture in an elderly patient: a case report. J NIPPON MED SCH 2011; 77:338-41. [PMID: 21206149 DOI: 10.1272/jnms.77.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An 80-year-old woman was admitted to our hospital with severe chest and back pains after vomiting. Computed tomography (CT) of the chest revealed left-sided pneumothorax and pleural effusion. Some food was drained from an inserted chest tube, and we diagnosed spontaneous esophageal rupture (Boerhaave's syndrome). A left thoracotomy was performed 7 hours after the onset of symptoms. A 3-cm perforation was discovered in the lateral wall of the distal esophagus. The perforation was repaired with a primary two-layered closure and covered with pericardial fat. The patient had a good postoperative course and was discharged 1 month after surgery. This case suggests the importance of early surgical treatment, even in elderly patients with spontaneous esophageal rupture.
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Affiliation(s)
- Eriko Shinozuka
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Abstract
OBJECTIVES The standard approach to benign esophageal perforations consists of conservative treatment or surgery. In this study, we investigated the efficacy of short-term stent placement for nonmalignant esophageal perforations. METHODS This is a prospective single-center study of patients with benign esophageal perforations in whom a removable self-expandable stent was placed. Data were collected from a prospective database, endoscopy records, and operation reports. To obtain follow-up data, we contacted the patients, their relatives, or their general practitioner. RESULTS A total of 33 patients underwent stent insertion owing to an iatrogenic perforation (n=19), Boerhaave's syndrome (n=10), or other causes (n=4); this resulted in an immediate and complete sealing of the lesion in 32 patients (97%). Stents migrated in 11 patients (33%). Four patients required an esophageal resection for failed stent therapy (n=3) and failed stent removal (n=1). The 90-day mortality rate was 15%. A total of 33 endoscopic stent extractions were attempted. Overall, 23 stents were extracted within 6 weeks (group I) and 10 stents between 6 and 84 weeks (group II). Extractions were uncomplicated in all patients in group I (100%) vs. in 5 patients in group II (50%) (P=0.001). Six extraction-related complications occurred in group II, including two self-limiting bleedings, three stent fractures, and one impacted stent. CONCLUSIONS In patients with a benign esophageal perforation, temporary stent therapy is effective and provides a good alternative to surgery. Complications due to stent removal can be prevented by removal of the prosthesis within 6 weeks after insertion, without compromising the efficacy of treatment.
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Cannon M. An 82-year-old Man With A 2-Day History of Vomiting and Epigastric Pain. J Emerg Nurs 2010; 36:36-7. [DOI: 10.1016/j.jen.2009.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 01/29/2009] [Accepted: 01/30/2009] [Indexed: 11/28/2022]
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Chiu YH, Chen JD, Hsu CY, How CK, Yen DHT, Huang CI. Spontaneous esophageal injury: esophageal intramural hematoma. J Chin Med Assoc 2009; 72:498-500. [PMID: 19762321 DOI: 10.1016/s1726-4901(09)70416-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute chest pain can indicate a life-threatening condition and it is important for physicians to diagnose and treat it as a matter of urgency. We report 1 rare case of esophageal intramural hematoma (IMH) that presented with chest pain at the emergency department and which was initially clinically suspected to be due to aortic dissection. The case was diagnosed preoperatively by multidetector computed tomography. Esophageal IMH may represent an intermediate stage between Mallory-Weiss tear (mucosal) and Boerhaave's syndrome (transmural). Multidetector computed tomography is a useful noninvasive imaging modality for accurate diagnosis of these spontaneous intramural and transmural ruptures of the esophagus, and aids in the differential diagnosis of aortic and other mediastinal diseases with acute chest pain.
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Affiliation(s)
- Yu-Hui Chiu
- Department of Emergency Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan, ROC
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Paediatric Boerhaave's syndrome: a case report and review of the literature. CASES JOURNAL 2009; 2:8302. [PMID: 19918414 PMCID: PMC2769424 DOI: 10.4076/1757-1626-2-8302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 08/07/2009] [Indexed: 11/08/2022]
Abstract
We report a case of paediatric Boerhaave's syndrome in 15-year-old girl associated with massive dilatation of the stomach into the pelvis and transient hepatitis of uncertain aetiology. This cluster of clinical finding has not previously been reported. The young girl initially presented with abdominal pain, vomiting and lower urinary tract symptoms. She was initially treated for urinary tract infection after urine dipstick showed leucocytes and nitrates. Later she was found to have the spectrum of findings as described. Patient was treated by restricting to strict no oral intake and gastric decompression. Enteral nutrition maintained via a feeding jejunostomy.Boerhaave's syndrome frequently presents in the context of other emetogenic illnesses which may mimic its features as a result the diagnosis can be difficult. A high index of clinical suspicion is therefore required. We review the literature of paediatric Boerhaave's syndrome to aid the clinician with this diagnostic conundrum.
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Hung JJ. Spontaneous rupture of the oesophagus (Br J Surg 2008; 95: 1115-1120). Br J Surg 2009; 96:951; author reply 951-2. [PMID: 19591155 DOI: 10.1002/bjs.6757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Abstract
Boerhaave syndrome is a rare entity which classically presents with perforation and mediastinal sepsis. The patients' outcome is directly related to the length of time required to diagnose and surgically address the syndrome. Atypical presentations can contribute to a delay in recognizing the phenomenon, which portends poorly. The case of a man with postemetic esophageal perforation presenting with a massive left hemothorax is presented. To the authors' knowledge, this is the only case of this type to be described in the literature.
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Griffin SM, Lamb PJ, Shenfine J, Richardson DL, Karat D, Hayes N. Spontaneous rupture of the oesophagus. Br J Surg 2008; 95:1115-20. [PMID: 18655213 DOI: 10.1002/bjs.6294] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. METHODS Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a non-operative approach, whereas the remainder underwent thoracotomy. RESULTS The median time to diagnosis was 24 (range 4-604) h. Initial diagnosis was by contrast swallow in 18 of 24 patients, computed tomography in 15 of 17 and endoscopy in 18 of 18. There were no deaths among 17 patients who were managed non-operatively with targeted drainage, intravenous antimicrobials, nasogastric decompression and enteral nutrition. Of 31 patients who underwent primary thoracotomy and oesophageal repair (over a Ttube in 29), 11 died in hospital. Three patients could not be resuscitated adequately and did not have surgical intervention. CONCLUSION Spontaneous oesophageal rupture represents a spectrum of disease. Accurate radiological and endoscopic evaluation can identify those suitable for radical non-operative treatment and those who require thoracotomy.
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Affiliation(s)
- S M Griffin
- Department of Upper Gastrointestinal Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Abstract
The anatomy of the esophagus is unique in that it traverses the neck, chest, and abdomen. As a result, surgeons need to be familiar with the anatomy of all three of these areas to be facile and comfortable in performing esophageal surgery. Traumatic injuries to the esophagus encompass a heterogeneous group of injuries that can be iatrogenic, external, or from physiologic forces. Primary repair of traumatic injuries is preferred when possible; however, if systemic sepsis is present and esophageal resection becomes necessary due to extensive injury or inflammation, immediate reconstruction should be delayed in most cases. Successful management of traumatic esophageal injuries requires prompt and accurate diagnosis and treatment tailored specifically to both the type of injury as well as to the patient's overall clinical condition.
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Affiliation(s)
- Scott B Johnson
- Division of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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Khan AZ, Forshaw MJ, Davies AR, Youngstein T, Mason RC, Botha AJ. Transabdominal Approach for Management of Boerhaave's Syndrome. Am Surg 2007. [DOI: 10.1177/000313480707300518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several transthoracic approaches have been described for the surgical management of Boerhaave's syndrome that carry their own morbidity in patients who can be systemically unwell at presentation, and best practice is not established. We introduce a novel transabdominal approach to manage the perforation and spare these patients the trauma of a thoracotomy. Four patients with spontaneous esophageal rupture were managed using a transabdominal approach. Postoperative complications, length of intensive care unit stay, postoperative hospital stay, time to oral intake, and morbidity and mortality were used as outcome measures. After operation, the median intensive care unit stay was 4 days (range, 0–5) in patients who required a median of 10.5 days (range, 6–17) to establish oral intake. One patient required a transthoracic drainage of an empyema and one patient required percutaneous drainage of a mediastinal collection. The median length of stay was 38 days and there was zero mortality. The transabdominal approach is safe and effective for the management of Boerhaave's syndrome and should be considered in the treatment paradigm for this condition. Intrathoracic complications account for postoperative morbidity.
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Affiliation(s)
- Aamir Z. Khan
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
| | - Mathew J. Forshaw
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
| | - Andrew R. Davies
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
| | - Taryn Youngstein
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
| | - Robert C. Mason
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
| | - Abraham J. Botha
- Department of Surgery, St. Thomas Hospital, London SE1 7EH, United Kingdom
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Prichard R, Butt J, Al-Sariff N, Frohlich S, Murphy S, Manning B, Ravi N, Reynolds JV. Management of spontaneous rupture of the oesophagus (Boerhaave’s syndrome): Single centre experience of 18 cases. Ir J Med Sci 2006; 175:66-70. [PMID: 17312833 DOI: 10.1007/bf03167971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Spontaneous oesophageal rupture (Boerhaave's syndrome) is rare, and carries a high attendant risk of mortality. METHODS A retrospective eight-year review from a tertiary unit. RESULTS Eighteen patients were managed, with a mean age of 57 (39 - 88 years). Eight patients presented early and underwent surgery, seven with primary closure and one with exclusion and diversion. There was one death in this group. Ten patients were managed conservatively. In this group, two underwent an oesophagectomy because of failed conservative measures, and four had an endoprosthesis inserted. One patient died in this group on the first admission, but two patients with stents in situ died from massive bleeding relating to an aorto-oesophageal fistula at 39 days and 189 days respectively following presentation. CONCLUSIONS Surgical intervention remains the gold standard when the diagnosis is made early. For late diagnoses, this series suggests caution in the use of endoprostheses.
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Affiliation(s)
- R Prichard
- Dept of Clinical Surgery, St James's Hospital and Trinity College Dublin
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Dagash HI, Baillie C, Lawson RAM, Will AM. Boerhaave syndrome following chemotherapy in a child with acute lymphoblastic leukemia. Pediatr Blood Cancer 2004; 43:91-2. [PMID: 15170899 DOI: 10.1002/pbc.20042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ochiai T, Hiranuma S, Takiguchi N, Ito K, Maruyama M, Nagahama T, Kawano T, Nagai K, Nishikage T, Noguchi N, Takamatsu S, Kawamura T, Teramoto K, Iwai T, Arii S. Treatment strategy for Boerhaave's syndrome. Dis Esophagus 2004; 17:98-103. [PMID: 15209751 DOI: 10.1111/j.1442-2050.2004.00361.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal rupture is a potentially mortal condition. Rapid and correct diagnosis, and urgent surgical treatment with esophagectomy is indicated, but conservative and other surgical treatments have also been reported recently. The treatment strategies for esophageal rupture are discussed here, based on our experiences with four cases during the last 10 years. They were admitted urgently and each was treated by a different method. Three of them underwent emergency operations, one undergoing primary closure of the ruptured esophagus, another received a T-tube insertion from the ruptured site with omental flap, and the third an esophagogastrectomy. The fourth case was treated conservatively. All patients survived and were discharged 36-144 days post treatment. One of them was readmitted for debridement of necrotic rib. In conclusion, the prompt and accurate diagnosis of esophageal rupture is crucial for a subsequent successful treatment. Conservative treatment or operation including esophagectomy will be determined by the severity of the condition.
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Affiliation(s)
- T Ochiai
- Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
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Benders NA, Veldhuis Kroeze EJB, van der Kolk JH. Idiopathic muscular hypertrophy of the oesophagus in the horse: a retrospective study of 31 cases. Equine Vet J 2004; 36:46-50. [PMID: 14756371 DOI: 10.2746/0425164044864697] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY To present the first report of a case series concerning equine idiopathic muscular hypertrophy of the oesophagus (IMHO). OBJECTIVES To investigate the clinical and pathological features of the disorder. METHODS The medical records of 31 horses suffering from the disorder were reviewed retrospectively. In all these animals the diagnosis was confirmed at post mortem examination. RESULTS The median age of the affected horses was 12.5 +/- 5.6 years (range 1-26) without sex or breed predilection. Only 2 out of 31 horses showed clinical signs associated with oesophageal dysfunction, indicating that the muscular hypertrophy was rather a coincidental post mortem finding. Histology revealed thickening of the distal portion of the oesophagus mainly involving the circular layer of the tunica muscularis without fibrosis or inflammation. In 8 cases, the disorder was seen in concurrence with idiopathic hypertrophy of the tunica muscularis of various other parts of the gastrointestinal tract. CONCLUSIONS In the majority of patients, IMHO was a coincidental finding at post mortem examination usually confined to the smooth, circular muscle layer of the tunica muscularis externa. POTENTIAL RELEVANCE Further research is necessary to study the precise effect of IMHO on oesophageal function.
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Affiliation(s)
- N A Benders
- Department of Equine Sciences, Medicine Section, Faculty of Veterinary Medicine, Utrecht University, PO Box 80.152, 3508 TD Utrecht, The Netherlands
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