Against all odds. Conservative management of Boerhaave's syndrome.
Spontaneous oesophageal perforation or Boerhaave's syndrome is a life-threatening condition that usually requires early diagnosis and early surgical management. A 79-year-old man presented to the accident and emergency department with an ischaemic left big toe. He reported a 2-week history of worsening symptoms and a claudication distance in his left leg of 20-30 m. Three days post-revascularisation of the leg, the patient reported chest pain radiating to the back. CT angiography of the aorta indicated Boerhaave's syndrome. Following 35 days of conservative management in the intensive care unit and high dependency unit, the patient was stepped down to a surgical ward. A water-soluble contrast study demonstrated minimal leak through the perforated oesophagus. The patient was started on oral intake, which was well tolerated. This case highlights that conservative management may be appropriate.
Department of Upper GI Surgery, Barts & The Royal London, London, UK.
Charles
C
Anwuzia-Iwegbu
Barts and The London School of Medicine & Dentistry, London, UK.
Yasser
Y
Al Omran
Colchester General Hospital, Colchester, UK.
Amelia
A
Heaford
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D004322:Drainage; D004939:Esophageal Perforation / Q000150:complications / Q000628:therapy*; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications / Q000628:therapy*; D008795:Metronidazole / Q000627:therapeutic use; D000077402:Pantoprazole; D010288:Parenteral Nutrition; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D015725:Fluconazole; D000077402:Pantoprazole; D010878:Piperacillin