Estorninho João, Pimentel Raquel, Gravito-Soares Marta, Gravito-Soares Elisa, Amaro Pedro, Figueiredo Pedro
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2022 Nov 25;30(6):444-450. doi: 10.1159/000527317. eCollection 2023 Dec.
Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.
博雷尔哈夫综合征（BS）是一种罕见但可能致命的疾病。尽管手术被认为是标准治疗方法，但内镜治疗作为一种微创管理手段已发挥重要作用。作者描述了2例中年男性患者，他们在剧烈用力和呕吐后出现自发性食管穿孔。在第一例中，患者表现为上段食管有骨嵌顿，通过硬式食管镜成功取出。术后，胸部X线/颈胸计算机断层扫描（CT）显示左侧液气胸和纵隔气肿，食管下段有口服造影剂漏出。在第二例中，患者在一次呕吐发作后因严重胸痛就诊于急诊科。CT显示大量纵隔气肿、皮下气肿以及与博雷尔哈夫综合征相符的口服造影剂漏出。该患者最初接受了手术缝合，但12天后造影剂外渗仍持续存在。在对两名患者进行多学科团队讨论后，进行了上消化道内镜检查，结果显示食管远端有周缘性壁缺损。使用套扎器（OTSC）成功封闭了这些缺损。经过至少9个月的随访，患者临床状况良好，无复发。作者强调了这些临床病例的严重性以及内镜治疗选项在处理博雷尔哈夫综合征中被证明具有决定性作用。良好的结果表明，套扎器方法在封闭自发性食管穿孔方面既可以作为一线治疗，也可以在手术失败后作为挽救治疗发挥作用。
