Use of reversed latissimus dorsi muscle flap for primary oesophageal repair reinforcement in Boerhaave's syndrome

Abstract

Listen

Translate article

AimBoerhaave's syndrome, or spontaneous oesophageal rupture, is a rare but serious condition. The pathology involved is a complete, transmural laceration of the oesophagus. The overall mortality rates are still high (range: 10–60 per cent). Outcomes of oesophageal perforations depend on the duration between diagnosis of perforation and treatment. Primary repair has been identified as the best treatment option, especially for presentation before 24 h. Mediastinal pleura, gastric fundus, pericardial flap and intercostal muscle flap are frequently used. Reversed latissimus dorsi (LD) muscle flap is another feasible option, especially when the intercostal muscle is inadequate and the length of perforation is long.Patients and MethodsA patient presented with Boerhaave's syndrome with left posterolateral thoracotomy done. Intraoperation found a 4‐cm, full‐thickness perforation over the distal oesophagus. Primary repair and reinforcement with reversed LD muscle flap was performed.ResultsThe patient had an uneventful recovery. Water‐soluble contrast enema confirmed no leakage. He was discharged on postoperative day 10.ConclusionPrimary repair and reinforcement with reversed LD muscle flap is a feasible option when the intercostal muscle is inadequate and the length of the oesophageal perforation is long.