Boerhaave’s syndrome: case report and review

THE CHOICE OF SURGICAL TACTICS FOR BOERHAAVE SYNDROME IN COMBINATION WITH BILATERAL PLEURAL EMPYEMA (CLINICAL CASE)

Introduction. Boerhaave syndrome is a rare, difficult to diagnose and formidable disease with a high mortality rate. For the treatment of this pathology, many variants of interventions have been proposed. Some surgeons prefer to use a thoracotomic access, others – a laparotomic transhiatal one. In the domestic literature there are scant observations of usement of minimally invasive technologies.Clinical observation. The patient was admitted to the surgical department for emergency indications. In the admission department spontaneous left side hydropneumothorax was diagnosted. Drainage of the left pleural cavity was performed. On the second day, a spontaneous rupture of the esophagus was diagnosed. Video-laparotranschiatal drainage of the posterior mediastinum, drainage of the left subhepatic space, Maydl jejunostomy was performed. In the postoperative period, intensive conservative therapy was carried out, massive lavage of the mediastinum and the left pleural cavity with antiseptic solutions. For a long time, there was a large drainage debit. Because of treatment the dynamics were positive. On the 45th day the drainage of the pleural cavity was removed. By the 66th day complete healing of the esophageal defect and removal of the mediastinal drainage.Discussion. Due to the difficulties in diagnosis, a spontaneous rupture of the esophagus was detected a day later. The applied surgical access and technique allowed to provide adequate drainage and sanitation of the posterior mediastinum and left pleural cavity. The subsequent tactics of managing the patient ensured his recovery. The trauma of the video-laparotranschiatal access is less, in comparison with open surgical interventions. We consider the experience of using video endoscopic technologies for Boerhaave syndrome positive and promising.