Department of Gastroenterology, Santo Tomas Hospital, Panama City, Panama.
Department of Thoracic Surgery, Santo Tomas Hospital, Panama City, Panama.
BMC Gastroenterol. 2021 Dec 20;21(1):484. doi: 10.1186/s12876-021-02058-z.
Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation.
We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis.
Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.
Boerhaave 综合征是一种罕见的疾病，约占所有食管穿孔的 15%。其中一部分患者患有嗜酸性食管炎，这是一种慢性食管炎症，穿孔风险约为 2%。食管穿孔很少会导致食管胸膜瘘的发生。由于缺乏高质量的证据和罕见的报道经验，食管胸膜瘘的治疗仍然是一个挑战。由于采用了与外部伤口相同的原理，即提供伤口引流和组织肉芽形成，腔内真空辅助治疗可能在管理中发挥作用。
我们报告了一例 24 岁的男性患者，患有嗜酸性食管炎并发食管破裂，随后发生食管胸膜瘘，成功采用腔内真空辅助治疗进行非手术治疗。据我们所知，这可能是首例报道的嗜酸性食管炎患者的病例。
腔内真空辅助治疗可能是 Boerhaave 综合征引起的嗜酸性食管炎和食管胸膜瘘患者的一种有效且新颖的策略。需要进行适当设计的研究。
