Anand Rohan, Puckett Yana, Ronaghan Catherine A
Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.
Surgery, West Virginia University School of Medicine, Charleston, USA.
Cureus. 2022 Apr 10;14(4):e24015. doi: 10.7759/cureus.24015. eCollection 2022 Apr.
Boerhaave syndrome, defined as a spontaneous rupture of the esophagus, is an uncommon clinical entity. Recurrent spontaneous rupture of the esophagus is even rarer and has only been described in a handful of case reports. The rupture most often occurs in the thoracic esophagus. Spontaneous rupture of the intraabdominal esophagus is extremely rare. The extravasation of gastric contents, including bile, acid, and bacteria, into a body cavity precipitates severe sepsis. This results in a high mortality rate without emergent treatment. Such treatment often necessitates surgical repair with primary closure, tissue grafts, or esophagectomy in particularly severe cases. This is a case of a 64-year-old male who suffered Boerhaave syndrome twice separated by two years. The patient was transferred from an outside facility initially presenting with chest and abdominal pain, which developed after eating. CT esophagram with water soluble contrast demonstrated contrast extravasation into the right mediastinum/hemithorax, consistent with a diagnosis of Boerhaave syndrome. Repair was accomplished with an intercostal muscle pedicle patch, and the patient was subsequently discharged. This case report details, to our knowledge, the first case of a left intraabdominal and right thoracic esophageal rupture combination.
博赫哈夫综合征定义为食管自发性破裂，是一种罕见的临床病症。食管反复自发性破裂更为罕见，仅有少数病例报告对此进行过描述。破裂最常发生在胸段食管。腹段食管自发性破裂极为罕见。胃内容物（包括胆汁、胃酸和细菌）渗入体腔会引发严重的败血症。若不进行紧急治疗，这会导致高死亡率。此类治疗通常需要进行手术修复，包括一期缝合、组织移植，在病情特别严重的情况下还需进行食管切除术。这是一例64岁男性患者，两次患博赫哈夫综合征，间隔时间为两年。该患者从外部医疗机构转来，最初表现为进食后出现的胸痛和腹痛。水溶性造影剂CT食管造影显示造影剂渗入右纵隔/半侧胸腔，符合博赫哈夫综合征的诊断。采用带蒂肋间肌补片完成修复，患者随后出院。据我们所知，本病例报告详细介绍了首例腹段食管左侧和胸段食管右侧破裂并存的病例。
