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Pickering O, Pucher PH, De'Ath H, Abuawwad M, Kelly J, Underwood TJ, Noble F, Byrne JP. Minimally Invasive Approach in Boerhaave's Syndrome: Case Series and Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:1254-1261. [PMID: 33400893 DOI: 10.1089/lap.2020.0751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Boerhaave's syndrome is a life-threatening spontaneous perforation of the esophagus associated with significant morbidity and mortality. Historically, thoracotomy has been the mainstay of treatment, but is associated with high morbidity and pain. Minimally invasive approaches provide alternative treatment possibilities. This systematic review together with inclusion of a case series from a tertiary esophagogastric unit assesses current evidence focused on minimally invasive surgical management of this condition. Methods: A systematic review was conducted in line with MOOSE (Meta-analyses Of Observational Studies in Epidemiology) guidelines. Electronic databases PubMed, MEDLINE, and Cochrane Library were searched, and articles focusing on the minimally invasive management of Boerhaave's syndrome were identified and scrutinized. We also report demographics and outcomes for a consecutive case series of patients with acute Boerhaave's syndrome managed via thoracoscopy. Results: Fifteen studies were included comprising 5 retrospective cohort studies and 10 case reports. Management strategies were divided into three categories: thoracoscopic, endoscopic, and laparoscopic. Overall mortality rates for each treatment modality were 2%, 13%, and 33%, and treatment success rates 98%, 38%, and 67%, respectively. Postoperative infective complications were seen in 79% of patients, with only 2 patients requiring salvage thoracotomy. In our local case series, we report 4 consecutive patients managed with thoracoscopy, with a 100% treatment success rate. Conclusion: Minimally invasive approaches in the management of Boerhaave's syndrome are safe and effective. We propose a selective management algorithm involving a minimally invasive approach to management of this life-threatening condition. Registered with local clinical outcomes team as service evaluation. (Approval number sev/0171).
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Affiliation(s)
- Oliver Pickering
- Department of General Surgery, St Mary's Hospital, Isle of Wight, Newport, United Kingdom
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Philip H Pucher
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Henry De'Ath
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- Department of General Surgery, Frimley Park Hospital, Frimley, United Kingdom
| | - Mahmoud Abuawwad
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Jamie Kelly
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - Timothy J Underwood
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fergus Noble
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
| | - James P Byrne
- Department of General Surgery, Southampton General Hospital, Southampton, United Kingdom
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Hanajima T, Kataoka Y, Masuda T, Asari Y. Usefulness of lavage and drainage using video-assisted thoracoscopic surgery for Boerhaave's syndrome: a retrospective analysis. J Thorac Dis 2021; 13:3420-3425. [PMID: 34277038 PMCID: PMC8264720 DOI: 10.21037/jtd-20-2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
Background Boerhaave’s syndrome has a high mortality rate due to respiratory failure, septic shock, and multiple organ failure. We had previously carried out primary repair with laparotomy and postoperative computed tomography-guided drainage for mediastinal abscess and empyema. However, this treatment prolonged mechanical ventilator days and length of intensive care unit stay. Therefore, we decided to carry out primary repair with laparotomy and add lavage and drainage using video-assisted thoracoscopic surgery. Methods From April 2004 to September 2018, 18 patients with Boerhaave’s syndrome were treated; 6 patients treated conservatively were excluded. Thus, 12 patients who underwent surgical treatment were divided into the computed tomography-guided drainage group (D group) (6 patients) and the lavage and drainage using video-assisted thoracoscopic surgery group (VATS group) (6 patients), and the two groups were retrospectively compared. Results The VATS group had significantly longer operation time than the D group {359 [328, 387] vs. 220 [155, 235] min, P=0.004}, but the ventilator-free days (VFDs) were significantly extended {24 [21, 24] vs. 10 [0, 17] days, P=0.02}, and the length of intensive care unit stay was significantly shortened {14 [8, 14] vs. 35 [29, 55] days, P=0.01}. Conclusions Lavage and drainage using video-assisted thoracoscopic surgery is an effective surgical method for Boerhaave’s syndrome.
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Affiliation(s)
- Tasuku Hanajima
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yuichi Kataoka
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Tomonari Masuda
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
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Zeyara A, Jeremiasen M, Åkesson O, Falkenback D, Hermansson M, Johansson J. Third time recurrent Boerhaave's syndrome: a case report. J Med Case Rep 2021; 15:223. [PMID: 33933141 PMCID: PMC8088656 DOI: 10.1186/s13256-021-02779-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Effort rupture of the esophagus or Boerhaave’s syndrome is a rare entity, and prognosis is largely dependent on early diagnosis and treatment. Recurrent effort ruptures are very rare, only reported in a few case reports in English literature. We present a case with a third time effort rupture, and to the best of our knowledge there are no such previous publications. Furthermore, the presented case is also distinct because each episode was treated by different methods, reflecting the pathophysiology of recurrent disease as well as the last decade’s advancements in the management of esophageal perforations in our clinic and globally. Case presentation The patient is a 60-year-old White male, suffering from alcohol abuse, mild reflux esophagitis, and a history of effort esophageal ruptures on two previous occasions. He was now admitted to our ward once again because of a third bout of Boerhaave’s syndrome. The first time, 10 years ago, he was managed by thoracotomy and laparotomy with primary repair, and the second time, 5 years ago, by transhiatal mediastinal drainage through a laparotomy and endoscopic stent placement. Now he was successfully managed by endovascular vacuum-assisted closure therapy alone. Conclusions Recurrent cases of Boerhaave’s syndrome are very rare, and treatment must be tailored individually. The basic rationale is, however, no different from primary disease: (1) early diagnosis, (2) adequate drainage of extraesophageal contamination, and (3) restoration of esophageal integrity. Recurrent disease is usually contained and exceptionally suitable for primary endoscopic treatment. To cover the full panorama and difficult nature of complex esophageal disease, endoscopic modalities such as stent placement and endovascular vacuum-assisted closure, as well as the capacity for prompt extensive surgical interventions such as esophagectomy, should be readily accessible within every modern esophageal center.
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Affiliation(s)
- Adam Zeyara
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden. .,Department of Surgery, Ystad Hospital, Ystad, Sweden.
| | - Martin Jeremiasen
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden.,Division of Esophageal and Gastric Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Oscar Åkesson
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden.,Division of Esophageal and Gastric Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Dan Falkenback
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden.,Division of Esophageal and Gastric Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Michael Hermansson
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden.,Division of Esophageal and Gastric Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Jan Johansson
- Department of Clinical Sciences in Surgery, Lund University, Lund, Sweden.,Division of Esophageal and Gastric Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
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Shibata R, Ozaki T, Tada K, Aoyama T, Watanabe M, Himuro N, Takahashi K, Ito K, Yasuno T, Miyake K, Masutani K, Uesugi N, Nabeshima K, Nakashima H. Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases. CEN Case Rep 2020; 9:385-391. [PMID: 32535843 DOI: 10.1007/s13730-020-00493-7] [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: 03/19/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022] Open
Abstract
Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.
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Affiliation(s)
- Ryoko Shibata
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tomomi Ozaki
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kazuhiro Tada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Takashi Aoyama
- Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Maho Watanabe
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoko Himuro
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Koji Takahashi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Katsuhisa Miyake
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Noriko Uesugi
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hitoshi Nakashima
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Nanakuma 7-45-1, Jonan-ku, Fukuoka, 814-0180, Japan
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Okamoto H, Onodera K, Kamba R, Taniyama Y, Sakurai T, Heishi T, Teshima J, Hikage M, Sato C, Maruyama S, Onodera Y, Ishida H, Kamei T. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018; 10:2206-2212. [PMID: 29850124 DOI: 10.21037/jtd.2018.03.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The mortality rate of spontaneous esophageal rupture remains 20% to 40% due to severe respiratory failure. We have performed thoracoscopic surgery for esophageal disease at our department since 1994. Sivelestat sodium hydrate reportedly improves the pulmonary outcome in the patients with acute lung injury (ALI). Methods We retrospectively evaluated the usefulness of thoracoscopic surgery and perioperative administration of sivelestat sodium hydrate for spontaneous esophageal rupture in 12 patients who underwent thoracoscopy at our department between 2002 and 2014. Results The patient cohort included 11 males and one female (median age, 61 years). The lower left esophageal wall was perforated in all patients. Surgical procedures consisted of thoracoscopic suture and thoracic drainage in six patients, transhiatal suture and thoracoscopic thoracic drainage in five, and thoracoscopic esophagectomy and thoracic drainage in one. The median time from onset to surgery was 8 hours with a surgical duration of 210 minutes, blood loss 260 mL, postoperative ventilator management 1 day, intensive care unit (ICU) stay 5 days, and interval to restoration of oral ingestion 13 days. Postoperative complications included respiratory failure in four patients, pyothorax in three, and leakage in one. There was no instance of perioperative mortality. Regarding perioperative administration of sivelestat sodium hydrate, the postoperative arterial oxygen partial pressure-to-fractional inspired oxygen ratio (P/F) and C-reactive protein (CRP) levels in the administration group were significantly better than those in the non-administration group on postoperative days 4 (P=0.035) and 5 (P=0.037), respectively. In contrast, there was no significant difference between the groups in median time of ventilator management, ICU stay, oral ingestion following surgery, or hospital stay. Conclusions Thoracoscopic surgery obtained acceptable results in all patients, including two with a significant time elapse from onset to treatment. Furthermore, sivelestat sodium hydrate was suggested to help improve postoperative respiration and inflammatory response.
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Affiliation(s)
- Hiroshi Okamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ko Onodera
- Department of General Practitioner Development, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Rikiya Kamba
- Department of Surgery, Osaki Citizen Hospital, Osaki, Japan
| | - Yusuke Taniyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Sakurai
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takahiro Heishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Jin Teshima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Makoto Hikage
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Sendai City Hospital, Sendai, Japan
| | - Chiaki Sato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shota Maruyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yu Onodera
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hirotaka Ishida
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
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