PS01.084: BOERHAAVE SYNDROME: CONTINUING CHALLENGE TO TREATMENT

Abstract

Abstract Background Boerhaave syndrome produces an extremely severe clinical profile due to extravasation of digestive secretions and food into the mediastinum and pleural space. Diagnosis is often delayed, since it is a rare disease and is usually confused with other equally serious pathologies. These factors contribute to its high mortality rate. We present a case which was previously treated in three different institutions and finally referred to our department. Methods 81 year old gentleman was diagnosed as Boerhaave syndrome on 23rd Jan 2017. He had treatment in three different institutions: right ICD in first center: feeding jejunostomy and venting gastrostomy in second center: over the scope clipping and hemoclip in third center. As he continued to have persistent leak of enteral contents and purulent discharge in ICD, he was referred to our department for further management, two months after the intial insult. Results Patient was optimised for surgery and transhiatal esophagectomy with esophago gastric anastomosis was done in our department. Operative findings: Abdomen entered through midline incision, hiatal peritoneum incised, gastro esophageal junction encircled and esophagus mobilised. It revealed purulent discharge from right hemithorax and a 4cm esophageal perforation along right lateral aspect of esophagus above GE junction.About 120ml of foul smelling pus drained. Considering unhealthy esophageal tissue, long rent and failed endotherapy it was decided to do transhiatal esophagectomy. Previous gastrostomy site closed in 2 layers with 3–0 PDS. Through left anterior sternomastoid incision cervical esophagus mobilised and transected at low neck level and the specimen was removed through the hiatus. A gastric tube was made with linear staples and brought into neck through posterior mediastenum by camera sheath technique. Esophago-gastric anastamosis completed with posterior stapled and anterior hand sewn technique. Post op period was uneventful. Conclusion Early diagnosis and appropriate therapeutic strategies can reduce the mortality rate of Boerhaave's syndrome. Early intervention reduces the morbidity and mortality. The mortality increases with increasing time post insult. our patient who had undergone multiple theraputic modalities in three different centers was succesfully managed with trans hiatal esophagectomy in our department. Disclosure All authors have declared no conflicts of interest.