Simões João, Lázaro André
General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Clinical Academic Center of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
General Surgery Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; General Surgery Unit, Oesophago-Gastric and Obesity Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Clinical Academic Center of Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Int J Surg Case Rep. 2021 Dec;89:106583. doi: 10.1016/j.ijscr.2021.106583. Epub 2021 Nov 9.
Boerhaave syndrome or spontaneous rupture of the esophagus wall is a rare life-threatening condition. It is more common in male gender and is due to a very swift rise in intraluminal pressure during vomiting. The patient usually presents with chest pain after vomiting. In some cases, there is subcutaneous emphysema in the neck or upper chest. Due to its rarity, the diagnosis is often not straightforward. Chest radiography can reveal pneumothorax, pleural effusion or pneumomediastinum, but diagnosis is more likely possible with an oral contrast X-ray study.
This paper reports a clinical case with surgical approach, in a 68-years old patient with a 48 h period between onset of symptoms and diagnosis of a Boerhaave syndrome. Firstly, the patient was admitted with a presumptive diagnosis of pneumonia. The patient was with chest pain, fever and vomiting. An emergent transhiatal esophagectomy was performed with primary anastomosis with no significant post-operative morbidity and allowing for the patient to return to previous daily routine with a good quality of life.
Boerhaave syndrome is a rare life-threatening surgical condition. Surgery is the most effective treatment. It is necessary to have a high index of suspicion. Treatment should promptly start because prognosis is related with time from diagnosis, with increasing mortality rate if no treatment is performed.
博雷尔哈夫综合征或食管壁自发性破裂是一种罕见的危及生命的疾病。该病在男性中更为常见，是由呕吐时管腔内压力迅速升高所致。患者通常在呕吐后出现胸痛。在某些情况下，颈部或上胸部会出现皮下气肿。由于其罕见性，诊断往往并不简单。胸部X线检查可显示气胸、胸腔积液或纵隔气肿，但口服造影剂X线检查更有可能做出诊断。
本文报告了一例68岁患者的临床病例及手术方法，该患者从症状出现到诊断为博雷尔哈夫综合征间隔48小时。首先，患者因初步诊断为肺炎入院。患者伴有胸痛、发热和呕吐。急诊行经裂孔食管切除术并进行一期吻合，术后无明显并发症，患者恢复了以往的日常生活，生活质量良好。
博雷尔哈夫综合征是一种罕见的危及生命的外科疾病。手术是最有效的治疗方法。必须保持高度的怀疑指数。应立即开始治疗，因为预后与诊断时间有关，若不进行治疗，死亡率会上升。
