title: Successful surgical strategy in a late case of Boerhaave's syndrome.
abstract: Boerhaave's syndrome refers to the spontaneous transmural rupture of the esophagus. Primary repair may be performed in patients who present within 24 h of perforation, and such cases have the best outcomes as most complications have not yet developed. However, the treatment of late perforations remains controversial. Various approaches and strategies to repair late perforations have been described in the literature, but there is no uniform approach. We present a case of Boerhaave's syndrome in which the patient underwent surgical repair 48 h after the acute event and was subsequently treated successfully. The initial approach included direct esophageal repair, a drainage series, and nutritional support via a feeding jejunostomy. Although the repair site was subsequently disrupted, the patient showed complete healing of the perforation after three weeks. We consider that our surgical treatment strategy is safe and technically feasible, and appears to be a promising alternative approach for the treatment of patients with late Boerhaave's perforation.
authors.affiliation: Gang Shen, Ying Chai, Guo-Fei Zhang, Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Shen
authors.affiliation: Gang Shen, Ying Chai, Guo-Fei Zhang, Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chai
authors.affiliation: Gang Shen, Ying Chai, Guo-Fei Zhang, Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
authors.forename: Guo-Fei
authors.initials: GF
authors.lastname: Zhang
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D004435:Eating; D004750:Enteral Nutrition; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D010535:Laparoscopy; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D013524:Surgical Flaps; D013536:Suture Techniques; D007507:Therapeutic Irrigation; D013908:Thoracotomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D014945:Wound Healing; D004935:Esophageal Diseases; D012422:Rupture, Spontaneous; D000072663:Spontaneous Perforation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Boerhaave’s perforation; Drainage; Nutritional support; Repair; Surgery