Laparoscopic treatment of Boerhaave's syndrome: a case report and review of the literature.
Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a rare life-threatening disease requiring urgent surgical management. Symptoms can masquerade many other clinical disorders like acute myocardial infarction, dissecting aneurysm or upper gastro-intestinal tract diseases. Without prompt diagnosis and treatment, Boerhaave's syndrome has a very high mortality rate. We report a case of perforation of the distal oesophagus. A 40-year-old male patient presented at the emergency department with a classic history of acute epigastric pain and dyspnoea after an episode of vomiting. On clinical examination we found a firm, tender abdomen and cervical subcutaneous emphysema. Boerhaave's syndrome was suspected on a clinical basis and was confirmed by thoraco-abdominal CT scan, showing an apparent pneumomediastinum and fluid at both lung bases. The patient underwent surgical repair of the distal oesophageal tear by laparoscopy. A mediastinal drain was left behind and a feeding gastrostomy was established. After initial improvement, the patient developed fever and dyspnoea. A thoracic CT scan revealed left-sided empyema. A thoracoscopic drainage of pus was performed and antibacterial and antifungal treatment was adapted. The patient recovered well and was discharged from the hospital 34 days after admission.
Toelen
C
C
Academic Surgical Center Stuivenberg, University of Antwerp, Antwerpen, Belgium.
Hendrickx
L
L
Van Hee
R
R
D000208:Acute Disease; D000328:Adult; D004935:Esophageal Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012422:Rupture, Spontaneous / Q000601:surgery; D013577:Syndrome