Spontaneous Rupture Of Esophagus Research Articles

Endoscopic management of Boerhaave syndrome: a comprehensive review of techniques, outcomes and future directions

Boerhaave syndrome, characterized by spontaneous esophageal rupture, presents a critical condition requiring prompt diagnosis and intervention to reduce morbidity and mortality. Traditionally managed with surgical intervention, advancements in endoscopic techniques have emerged as viable alternatives, offering less invasive options with promising outcomes. This article provides a thorough review of the endoscopic management of Boerhaave syndrome, detailing the indications, techniques, and outcomes associated with various endoscopic approaches. We examine the role of esophageal stenting, clipping, and tissue sealants, alongside adjunctive therapies. Furthermore, we discuss patient selection criteria, procedural considerations, and potential complications. Our review highlights the evolving landscape of Boerhaave syndrome management, underscoring the importance of multidisciplinary collaboration and the need for further research to optimize patient outcomes.

344. SURGICAL APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE: THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY

Abstract Objective To explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate. Methods A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy. Results Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P < 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P > 0.05). Conclusion Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.

606. THE CHANGES OF THORACOSCOPIC OR LAPAROSCOPIC APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE IN JAPAN

Abstract Background The surgical treatment for esophageal rupture includes various approaches such as thoracotomy, laparotomy, thoracoscopy, and laparoscopy. These approaches aim to: Suture the perforation site, sealing it with omentum. or esophageal resection and reconstruction. Cleanse and drain the mediastinum or thoracic cavity. Adding gastrostomy or intestinal as needed. Many reports showed the usefulness of minimally invasive surgeries. In this study, we added our cases and discussed the surgical techniques and outcomes. Method I searched for reported cases in PubMed and the Journal of Health Care and Society and supplemented them with my experimental cases for analysis. All reports published between 2001 and the end of 2022 were included in this study. Results From 2001 to 2022, there have been 15 reports (16 cases) of idiopathic esophageal rupture using arthroscopic techniques, including our cases, 14 cases in men and 3 cases in women. The ages of the patients ranged from 39 to 78 years (mean 61 years, median 61 years), and the rupture sites were the lower esophagus in 15 cases (88%) and the middle part in 2 cases (12%). The time from onset of symptoms to surgery ranged from 4 to 77 hours. The approach method was thoracoscopy in 7 cases (41%), laparoscopy in 8 cases (47%), and a combination of thoracoscopic and laparoscopy in 2 cases (12%). Complications of Clavien-Dindo classification IIIa or higher were observed in 3 patients (18%). There were two cases each of thoracoscopic and laparoscopic complications in which complications were observed. The time from arthroscopic surgery to discharge was 12-120 days (mean 36.7 days, median 30.5 days). For cases with a thoracoscopic approach, the period from surgery to discharge is 23-120 days (average 50.1 days, median 39 days), and for cases with a laparoscopic approach, the period from surgery to discharge is 12-82 days (average 30 days). days, median 21 days). Discussion Spontaneous esophageal rupture develops various disease patterns such as mediastinum limited type with mild symptoms and intrathoracic rupture type. There are various treatment approaches, including conservative therapy, endoscopic closure, and surgery. The laparoscopic approach seemed to reduce the length of hospital stays. Conclusion The surgical approach for spontaneous esophageal rupture has been changed from thoracotomy to laparoscopic surgery. The trans hiatal procedure will increase among laparoscopic surgery. Spontaneous esophageal rupture is a remarkably highly invasive disease, and we thought that a less invasive and simpler treatment would be desirable.

Outcome of treatment modalities for spontaneous esophageal rupture: a meta-analysis and case series.

Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity. To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options. We enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. We also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before April 1, 2024, for inclusion in the meta-analysis. This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, we obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% confidence interval [CI]: 0.08-0.15). The combined re-intervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment > 24 h later was 12% (95% CI: 0.08-0.18). Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.

Mediastinitis and septic shock complicating spontaneous esophageal rupture “Boerhaave’s syndrome”: a case report

Boerhaave’s syndrome, also known as spontaneous esophageal rupture, is a rare but life-threatening condition characterized by a tear in the esophagus. It is most commonly caused by a sudden increase in intraesophageal pressure, often due to severe vomiting or retching.Early diagnosis of Boerhaave’s syndrome is crucial for improving patient outcomes. The classic triad of symptoms includes severe chest pain, vomiting, and subcutaneous emphysema (air under the skin). However, not all patients present with this triad, and the diagnosis can be challenging, especially in patients without the typical symptoms.In this case report, we present the clinical details of a 52-year-old male patient who presented to the emergency department (ED) with severe abdominal pain and vomiting for several days. The patient had a history of chronic alcohol abuse and a recent episode of vigorous vomiting.

A Critical Combination of Esophageal Rupture and Upside-down Stomach: A Case Report.

Spontaneous esophageal rupture, or Boerhaave syndrome, and upside-down stomach are rare pathologies associated with grave sequelae. Boerhaave syndrome can have a mortality rate as high as 44%. Upside-down stomach accounts for less than 5% of hiatal hernias and can lead to incarceration and volvulus. An 80-year-old woman presented to the emergency department with sudden onset, severe epigastric pain. Physical examination revealed normal vital signs with mild epigastric tenderness. Imaging obtained revealed a large hiatal hernia and findings concerning for esophageal perforation. The patient was started on 3.375 grams of intravenous piperacillin/tazobactam, and transfer to a tertiary care facility was initiated. After transfer, esophagography confirmed a perforation near the gastroesophageal junction and findings consistent with an upside-down stomach. The patient underwent successful repair of the esophageal perforation and gastropexy followed by intensive care unit admission and ultimately discharge. Boerhaave syndrome and upside-down stomach are two conditions with high associated morbidity and mortality requiring prompt intervention. Information obtained in the history and physical examination including acute onset of chest pain after vomiting, tachypnea, subcutaneous emphysema, and hypoxia can assist in the diagnosis of the described pathologies. These signs and symptoms can be subtle on examination but are important in raising clinical suspicion for an otherwise rare etiology for acute onset chest pain.

Surgical treatment of Boerhaave syndrome in the past, present and future: updated results of a specialised surgical unit.

Boerhaave syndrome is a rare clinical entity associated with high rates of morbidity and mortality. Early recognition of the symptoms, and identification of the site and extension of the injury are key in improving the prognosis. This study presents data on the mortality, morbidity and length of hospital stay in patients diagnosed with Boerhaave syndrome. The data were retrieved from a prospectively collected database in a single surgical unit between 2012 and 2022. The study makes a comparison with the surgical outcomes of the previous decade. Some 33 patients were diagnosed with Boerhaave syndrome and were treated surgically between 2012 and 2022 in a specialist upper gastrointestinal surgical unit. All patients underwent standard surgical repair (in-theatre diagnostic endoscopy, T-tube placement through thoracotomy and feeding jejunostomy through laparotomy). The mean size of the defects in the oesophageal lumen was 3.3cm. Delayed presentation was noted for 13 patients (39%); 8 patients (24%) died in hospital, and 19 patients (58%) developed postoperative complications. Mortality was similar to the rate recorded for the 20 patients from the previous decade (24% vs 20%, respectively). The mean length of hospital stay was 41 days, and was comparable to the 35.7 days reported between 1997 and 2011. Early and aggressive management of spontaneous oesophageal rupture ameliorates the postoperative recovery and prognosis. The surgical results of our unit were found comparable to the previous decade in the population of patients who were treated surgically.

Diagnosis and treatment of spontaneous esophageal rupture (Boerhaave syndrome): A case report and literature review

Abstract We present a case report of spontaneous esophageal rupture (Boerhaave syndrome) has been successfully treated at Viet Duc University Hospital. Through this case report, we reviewed the literatures on this rare disease's pathogenesis, diagnosis, and treatment methods. Keywords: Boerhaave syndrome; Endoscopic Vacuum-Assisted Closure Therapy; Endoscopic Vacuum Therapy

Boerhaave’s Syndrome: Better Late than Never – Delayed Management Using Endoscopic Over-the-Scope Clip

Boerhaave syndrome is spontaneous rupture of distal esophagus, caused by sharp increase intra esophageal pressure and negative intrathoracic pressure as with sudden forceful vomiting or retching. Classical Mackler clinical triad consists of vomiting, chest pain and subcutaneous emphysema. Mediastinal infection and sepsis are serious complications and can result in mortality upto 30 %, delay in treatment results in significant increase in mortality and morbidity. Early surgery is the best treatment option, surgery in elderly patients with multiple comorbid illness is challenging. Availability of full thickness closure devices using endoscopy like OTSC clips has a role in treating such group of patients. We present a elderly person who presented to us late and successfully managed endoscopically

408. COMPARISON OF THE SHORT-TERM EFFICACY OF THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY IN THE TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

Abstract Background Early and thorough intrathoracic debridement，irrigation and catheter drainage are of great significance for the healing of esophageal rupture. This study aims to explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate. Methods A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy. Results Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P < 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P > 0.05). Conclusion Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.

Outcome after stent and endoscopic vacuum therapy-based treatment for postemetic esophageal rupture

Objectives Extent of surgical repair of spontaneous esophageal effort rupture (Boerhaave syndrome) has gradually decreased by the emergence of minimal invasive treatment based on endoscopic stent sealing of the perforation. However, for this diagnosis, use of endoscopic vacuum therapy (EVT) is still in its beginning. We present our results after 7-years with both stent and/or EVT-based treatment. Materials and methods 17 consecutive patients with Boerhaave syndrome from June 2015 to May 2022 were retrospectively registered in a database. The perforation was sealed by stent and/or EVT, and gastric effluent was drained transthoracically by a chest tube or pigtail catheter. Eight out of 14 patients responded to questions on fatigue and dysphagia (Ogilvie’s score). Results Seventeen patients aged median 67 years (range 34–88), had a primary hospital stay of 38 days (7–68). Ninety-day mortality was 6% (n = 1). Perforations were sealed with stent (n = 10), EVT (n = 3) or stent and EVT (n = 4). One patient (6%) needed laparoscopic lavage and transhiatal drainage. Eight patients (47%) were re-stented due to persistent leakage (n = 4) and stent migration (n = 4). Fifteen patients (88%) had complications, including multi-organ failure (n = 9), pleural empyema (n = 8) and esophageal stricture (n = 3). The perforations healed. After 35.5 months (range 2–62) fourteen patients were alive. Eight that responded had no dysphagia and total fatigue score comparable to an age-matched reference population. Conclusion Mortality rate was low after initial stent and EVT-based treatment of Boerhaave syndrome, combined with adequate transthoracic drainage of gastric effluent. Patients required repeated minimal invasive procedures, but with no apparent negative effect on functional outcome.

Spontaneous esophageal rupture visualized by means of transthoracic echocardiography.

Spontaneous esophageal rupture visualized by means of transthoracic echocardiography.

Treatment strategies for advanced spontaneous esophageal rupture.

Treatment strategies for advanced spontaneous esophageal rupture.

Risk factors for the poor prognosis of Benign esophageal perforation: 8-year experience

BackgroundEsophageal perforation (EP) has a high mortality rate and poor prognosis. This single-center retrospective study aims to analyze the related risk factors for benign EP.MethodsWe retrospectively analyzed 135 patients with benign EP admitted to the First Affiliated Hospital of Nanchang University from January 2012 to December 2020. Univariate and multivariate logistic analysis were performed to estimate risk factors for prognosis of esophageal perforation patients.ResultsThere were 118 EP patients with foreign body ingestion and 17 patients with nonforeign body ingestion. Fish bones (78/118) were the most common foreign body and most of the nonforeign EPs were caused by spontaneous esophageal rupture (14/17). Foreign body perforations occurred mostly in the upper thoracic segment (70/118) and middle thoracic segment (31/118), and spontaneous esophageal ruptures occurred mostly in the lower thoracic segment (15/17). Fifteen patients (11.1%) died during hospitalization or within one month of discharge. Multivariable logistic regression analysis showed that high white blood cell (WBC) levels [odds ratio (OR) = 2.229, 95% confidential interval (CI): 0.776–6.403, P = 0.025], chest or mediastinal emphysema (OR = 7.609, 95% CI: 2.418–23.946, P = 0.001), and time to treatment > 72 h (OR = 3.407, 95% CI: 0.674–17.233, P = 0.018) were independent risk factors for poor prognosis.ConclusionForeign body was the major reason for benign EP. High WBC level, chest or mediastinal emphysema and time to treatment > 72 h were risk factors for poor prognosis.

Spontaneous Rupture of Esophageal Diverticulum—A Case Report and Literature Review

The spontaneous rupture of the esophageal diverticulum is a rare condition that occurs without any warning signs. Its incidence is low, but the mortality rate is high. This paper reports a case of spontaneous esophageal diverticulum rupture and analyzes it along with 13 other cases to explore its prevention and treatment measures. When patients suffer from chronic swallowing difficulties and chest pain or vomiting that cannot be explained after meals, they should be suspected to have a possible spontaneous rupture of the esophageal diverticulum, which is critical to the patient's prognosis.

An endoscopic approach to therapy for spontaneous esophageal rupture.

Video.

Outcomes after hybrid minimally invasive treatment of Boerhaave syndrome: a single-institution experience

Background Spontaneous esophageal perforation or Boerhaave syndrome is a life-threatening emergency, associated with significant morbidity and mortality. In this retrospective series we describe our single-center experience with a hybrid minimally invasive treatment approach for the treatment of Boerhaave syndrome. Methods Clinical data of all patients who presented with spontaneous esophageal rupture between January 2009 and December 2019 were analyzed. All patients underwent esophageal endoscopic stenting to seal the perforation and debridement of the contaminated mediastinal and pleural cavity through video-assisted thoracoscopic surgery (VATS). Primary outcome measure was defined as in-hospital death and 30-day mortality. Results Twelve patients were included with a median age of 63 years (interquartile range [IQR] 51–74 years) of whom 58% (n = 7) were male. The median Pittsburg perforation severity score was 6.5 (IQR 6–9). Endoscopic reintervention was required in 8 patients (67%), primarily due to stent dislocation. In addition, 5 patients (42%) required re-VATS due to empyema formation. Thirty-day mortality and in-hospital mortality were respectively 17% (n = 2) and 25% (n = 3). Conclusion Endoscopic stenting in combination with thoracoscopic debridement is an effective and safe minimally invasive hybrid approach for the treatment of Boerhaave syndrome. This is depicted by the relatively low mortality rates, even among patients with high perforation severity scores. The relatively low mortality rates may be attributed to the combined approach of rapidly sealing the defect and decontamination of the thorax. Future studies should aim to corroborate this evidence which is limited by its sample size and retrospective nature.

Subtotal esophagectomy followed by subtotal gastric reconstruction for Boerhaave's syndrome: Case report with literature review.

IntroductionBoerhaave's syndrome, or spontaneous esophageal rupture, is a potentially fatal disease requiring prompt diagnosis and effective treatment. We report Boerhaave's syndrome in a patient who underwent subtotal esophagectomy and temporary cervical esophagostomy for esophageal perforation to the right thoracic cavity, followed by subtotal gastric reconstruction as the second step.Presentation of caseA 70-year-old man with diarrhea and vomiting as chief complaints had underlying disease of reflux esophagitis. He experienced frequent hematemesis. Computed tomography (CT) at another hospital revealed right pleural effusion and abnormal mediastinal air and fluid retention around the esophagus, and he was transferred to our hospital. From the CT findings, he was diagnosed as having Boerhaave's syndrome with esophageal perforation into the right thoracic cavity. He was in shock, and emergency right thoracotomy was performed, revealing a severely purulent thoracic cavity, ruptured parietal pleura, and 5-cm perforation in the right front middle esophageal wall that was surrounded by mucosal necrosis. Subtotal esophagectomy, temporal cervical esophagostomy, and enteral feeding tube insertion were performed. After hospital discharge, he underwent subtotal gastric reconstruction 43 days postoperatively. His course was good, and he was transferred to another hospital for rehabilitation 36 days after reconstruction.DiscussionIn Boerhaave's syndrome, depending on the size of the perforation and fragility of the esophageal wall, subtotal esophagectomy may be feasible.ConclusionTwo-step reconstruction following esophageal rupture is possible after sufficient local infection control, and anastomosis can be performed if the patient's general condition is good, but only under conditions that guarantee no anastomotic leakage.

Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis

Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.
 Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, blind mediastinal drainage. The second group (n=23) consisted of patients treated with programmed re-thoracotomy. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's 2 test.
 Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis 1.5 times, mortality almost 2 times.
 Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

胸部上部食道に生じた特発性食道破裂の1例(A case of spontaneous rupture of the upper esophagus)

要旨特発性食道破裂は胸部下部食道の左壁に好発するが，今回胸部上部食道に生じた特発性食道破裂の1例を経験したので報告する。症例は61歳の男性，肉塊が食道につかえ，吐出努力繰り返すも改善ないことから前医へ搬送された。胸腹部単純CTにて食道第1狭窄部直下に詰まった食道異物と広範な縦隔気腫を認め，当院へ転送された。内視鏡検査にて食道入口部直下に食道を塞ぐ大きな肉塊を認め，それを押し込むと停滞部直下に縦走潰瘍が形成されており，胸部上部食道が穿孔部と判断した。状態は安定しており保存的加療を行い，15日目に退院となった。胸部上部食道における特発性食道破裂は非常に稀ではあるが，本症例は，肉塊が一度食道内に詰まり，吐出しようと努力を繰り返した際に肉塊の下で食道内圧が亢進したことで同部位に穿孔が生じたものと思われた。