Spontaneous rupture of the oesophagus: Boerhaave's syndrome in 2008. Literature review and treatment algorithm.
OBJECTIVE
Boerhaave's syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature.


METHODS
A systematic literature review written in the English language since 1975.


RESULTS
We reviewed all known literature. Treatment of the Boerhaave syndrome was divided into three categories: conservative, endoscopic and surgical approach. The survival rate of all treatments was 75, 100 and 81%, respectively.


CONCLUSIONS
Boerhaave's syndrome should be treated endoscopically when diagnosed within 48 h and when there are no signs of sepsis. However, when a patient is diagnosed within 48 h and has a septic profile, thoracotomy with hemifundoplication and pleural/mediastinal drainage should be performed; and in case of intra-abdominal leakage, a laparotomy for local repair should be performed. When a patient is diagnosed after 48 h, conservative treatment should be followed and only when a patient gets a septic profile is surgical treatment indicated.
de Schipper
J P
JP
Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, The Netherlands.
Pull ter Gunne
A F
AF
Oostvogel
H J M
HJ
van Laarhoven
C J H M
CJ
D000465:Algorithms; D003646:Debridement; D004935:Esophageal Diseases / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery; D006801:Humans; D012422:Rupture, Spontaneous; D013908:Thoracotomy