Jansen Jos C, van Dop Willemijn A, Fockens Paul, Löwenberg Mark
AMC Amsterdam, afd. Maag-darm-leverziekten, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2013;157(35):A6374.
Boerhaave's syndrome is a spontaneous oesophageal rupture caused by excessive vomiting. Left untreated the mortality rate is high. Surgical intervention was always the treatment of first choice, but increasingly a minimally invasive approach involving the endoscopic placement of an oesophageal stent is being carried out.
A 55-year-old man with no previous history presented at the Emergency Department complaining of pain in the upper abdomen that had come on suddenly after excessive vomiting. On CT scan Boerhaave's syndrome was diagnosed. An oesophageal stent was placed. The postoperative course was complicated by mediastinal and pleural abscesses for which surgical debridement was required. After 2 months the patient was discharged to a rehabilitation centre.
Surgical intervention is indicated if a patient with Boerhaave's syndrome is haemodynamically unstable or has sepsis, and the diagnosis is made within 24 hours. In all other cases a minimally invasive approach involving antibiotics, pleural drainage and endoscopic stent placement should be considered.
博赫哈夫综合征是一种由剧烈呕吐导致的自发性食管破裂。若不治疗，死亡率很高。手术干预一直是首选治疗方法，但越来越多地采用涉及内镜下放置食管支架的微创方法。
一名既往无病史的55岁男性因剧烈呕吐后突然出现上腹部疼痛而到急诊科就诊。CT扫描诊断为博赫哈夫综合征。放置了食管支架。术后病程因纵隔和胸膜脓肿而复杂化，需要进行外科清创术。2个月后患者出院前往康复中心。
如果博赫哈夫综合征患者血流动力学不稳定或患有脓毒症，且在24小时内确诊，则应进行手术干预。在所有其他情况下，应考虑采用包括抗生素、胸腔引流和内镜支架置入的微创方法。
