Ariza-Traslaviña Julián, Caballero-Otálora Nicolás, Polanía-Sandoval Camilo Andrés, Perez-Rivera Carlos J, Tellez Luis J, Mosquera Manuel
Thoracic Surgery Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia.
Int J Surg Case Rep. 2023 Feb;103:107881. doi: 10.1016/j.ijscr.2023.107881. Epub 2023 Jan 11.
Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures.
A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present.
The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient's outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction.
In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.
