Challenges in the Management of Complicated Boerhaave’s Syndrome
Presenting Author :
H.Sakthivel ,Chennai , India ( email@example.com)
Co – Authors : M Kanagavel, Apsara Chandramohan, Professor Balaji Singh, Professor SM Chandramohan
Spontaneous esophageal perforation (Boerhaave’s Syndrome) is one of the rare causes of esophageal perforation. The rate of misdiagnosis is as high as 50 % because of its nonspecific symptoms. It is a true surgical emergency with high morbidity and mortality. Varied modalities of treatment are available (Endoscopic / Surgical) for the management of the same. Here we discuss the challenges faced in the management of 16 cases of Complicated Boerhaave’s Syndrome in our department.
16 cases of complicated Boerhaave’s syndrome managed by a single surgical team were analyzed. Patients demographic variables, average time of presentation, evaluation done, modalities of treatment adopted and outcomes were analyzed.
We analyzed 16 patients of complicated Boerhaave’s Syndrome managed in our department. 11 patients were initially diagnosed as Cardiac or pleuritic chest pain and evaluated for cardiac, pulmonary or non-esophageal thoracic cause. 5 patients were managed outside as Boerhaave’s syndrome and referred to us. All patients were male patients.
Age range was 22- 81 years (Mean – 42.4). The most common initial presenting symptom was chest pain followed by dyspnea. History of ethanol use was present in 6 patients. Initial presentation was pyothorax in 7 patients, pleural effusion in 7 patients and unstable angina in 2 patients. The median delay in diagnosis was 16 days (Range – 11– 40 days). All patients but one had perforation in the lower third of esophagus. The perforation was into the right pleural cavity in 6 patients, left pleural cavity in 8 patients and both in 2 patients. 1 patient was managed conservatively, Transhiatal esophagectomy was done in 8 patients, abdominal and right thoracic approach esophagectomy was done in 6 patients and left thoracoabdominal approach esophagectomy was done in 1 patient. Average length of hospital stay was 18 days and there was no mortality. In the follow up 1 patient developed anastomotic stricture for which revision of anastomosis was done. After a median follow up of 30 months all our patients are symptom free.
Boerhaave’s syndrome is a surgical emergency and needs immediate intervention
(Endoscopic / Surgical). For delayed presentation surgery is the mainstay of treatment
with good outcomes after esophagectomy. Patients who survive the acute insult have good outcomes after the surgical intervention.