Laparoscopic Treatment of Boerhaave’s Syndrome: a Case Report and Review of the Literature

Abstract

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.

Key Words:

• Oesophagus rupture
• Boerhaave
• pneumomediastinum

Additional information

Notes on contributors

R. Van Hee

R. Van Hee Academic Surgical Center Stuivenberg General Center Hospital Antwerp Lange Beeldekensstraat 267 B-2060 Antwerpen, Belgium Tel.: [phone] Fax: [phone] E-mail: [email protected]