Pinto Maria João Ferreira, Rodrigues Pedro, Almeida Leonor, Leitão Alexandra, Flores Luís, Gomes André, Rocha Gonçalo, Friões Fernando
Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal.
Pneumology Department, Centro Hospitalar de São João, Porto, Portugal.
Eur J Case Rep Intern Med. 2018 Oct 24;5(10):000944. doi: 10.12890/2018_000944. eCollection 2018.
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.
Boerhaave syndrome is a complete rupture of the oesophageal wall secondary to a sudden increase in intraluminal oesophageal pressure, often in the lower third and left lateral position of the oesophagus.The management of Boerhaave syndrome depends on the time of diagnosis and clinical presentation and includes conservative, endoscopic and surgical approaches.Curative, aggressive approaches focused on the treatment of disease are often not appropriate for an aging population, hence the need for a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.
Boerhaave综合征罕见，临床表现不具特异性，最常见于持续性呕吐后发生。由于纵隔、胸膜腔和腹腔广泛感染，感染性休克主导临床表现。Boerhaave综合征目前的治疗方法包括保守治疗、内镜治疗和手术治疗。作者介绍了一例94岁男性患者，因社区获得性肺炎伴轻度呼吸功能不全入院，呕吐后并发食管穿孔及左侧大量胸腔积液。鉴于患者年龄较大，选择了放置食管支架的内镜治疗方法。住院期间因胸腔积液感染而复杂化，需要使用广谱抗生素并更换支架。患者住院60天后出院，无需吸氧，卡氏功能状态量表评分为80%。平均预期寿命的增加需要采取个案处理方法，权衡侵入性操作的益处和出院可能性与可接受的生活质量，以避免无效的医疗治疗。
Boerhaave综合征是食管壁的完全破裂，继发于食管腔内压力突然升高，常发生在食管下段左侧。Boerhaave综合征的治疗取决于诊断时间和临床表现，包括保守治疗、内镜治疗和手术治疗方法。针对疾病的根治性、积极治疗方法通常不适用于老年人群，因此需要采取个案处理方法，权衡侵入性操作的益处和出院可能性与可接受的生活质量，以避免无效的医疗治疗。
