Spontaneous Rupture Of Esophagus Research Articles

急性胃腸炎に併発した28歳特発性食道破裂の1例

急性胃腸炎に併発した若年特発性食道破裂例を経験したので報告する．症例は28歳の男性で，急性胃腸炎に伴う下痢，嘔吐の直後から強い胸背部痛出現したため近医受診．精査加療目的に救急車にて当院搬送となった．来院時胸部X線写真で左下肺野に透過性低下，CT検査では左胸水，胸部下部食道周囲に縦隔気腫を認めた．また，上部消化管造影検査で胸部下部食道左側から左胸腔内への造影剤流出を認めたため，特発性食道破裂と診断した．そこで，発症10時間後に緊急手術となった．左第7肋間後側方開胸を行うと，胸部下部食道左側に5mm大の穿孔と胸腔内に食物残渣を認めた．炎症所見が軽度のため，穿孔部を2層に縫合閉鎖した．術後経過は良好で第10病日に経口摂取を開始し，第21病日に退院した．急性胃腸炎は日常よくある疾患だが，若年であっても特発性食道破裂をきたすことがあることは念頭に置くべきと考えられた．

胸腔鏡下の単純縫合閉鎖術で救命しえた特発性食道破裂の1例

胸腔鏡下の単純縫合閉鎖術で救命しえた特発性食道破裂の1例

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Clinical Investigation of Treatment for Spontaneous Esophageal Rupture

Clinical Investigation of Treatment for Spontaneous Esophageal Rupture

Treatment for Spontaneous Esophageal Rupture (Boerhaave Syndrome); Experience with Surgical Treatment in 14 Cases

Treatment for Spontaneous Esophageal Rupture (Boerhaave Syndrome); Experience with Surgical Treatment in 14 Cases

Clinical Study on the Treatment Outcome and Strategy for Spontaneous Esophageal Rupture

Clinical Study on the Treatment Outcome and Strategy for Spontaneous Esophageal Rupture

Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial.

Boerhaave's syndrome (BS), also known as "spontaneous rupture of the esophagus", constitutes an emergency that requires early diagnosis if death or serious morbidity are to be prevented. First described in 1724, BS is thought to be more common than once thought. Its true incidence remains unknown. Mortality ranges between 20-40% with timely treatment but this rises to virtually 100% if treatment is delayed by more than 48 hours. This is unfortunately a common occurrence due to delayed diagnosis. The commonest precipitating factor is vomiting but BS can be truly "spontaneous". The classical clinical presentation described consists of vomiting, chest pain, and subcutaneous emphysema. However, and contrary to popular belief, this triad is actually uncommon accounting for the frequently delayed diagnosis. A less recognised presenting feature of BS is with pneumothorax due to associated rupture of the parietal pleura. Pneumothorax has been shown to be present in more than 20% of cases of BS-sometimes with a coexistent pleural effusion (hydropneumothorax). This article aims to raise awareness about pneumothorax as the sole initial presenting feature of BS and alert clinicians to consider BS in the differential diagnosis of any patient with respiratory symptoms and a recent history of vomiting.

Spontaneous Esophageal Rupture: A Rare Cause of Chest Pain

Spontaneous Esophageal Rupture: A Rare Cause of Chest Pain

Douleurs thoraciques d’origine viscérale

Although chest pain can be ascribed to a rheumatologic condition in every three cases, rheumatologists should not miss life-threatening disorders like myocardial ischaemia, pulmonar embolism, aortic dissection, aortic aneurysm, cardiac tamponade, severe pericarditis or myocarditis. In rare event, chest pain can herald the dissection of pulmonary artery. The diagnosis of pneumonia, pleuresia, mesothelioma and pneumothorax can be tricky. Drepanocytosis can also manifest as severe pain in the chest. Diaphragm has been proposed as the origin of pain in shrinking lung syndromes from lupus patients. Hernia through the anterior diaphragmatic foramen (Morgagni's herniation) can also induce retrosternal pain. Mediastinal tumors, mediastinal fat necrosis, and thymic disorders, from hemorragiae to infarctus, can be disclosed by chest pain, as well as the even more severe infections, pneumo-mediastins and mediastinal bleedings within mediastin (sometimes linked to the breakage of a parathyroid adenoma). Regurgitations, spasms, and functional disorders of esophagus can manifest as angina-like chest pain, as well as some esophageal ulcers and cancers. Spontaneous esophageal rupture following forced vomiting (Boerhave syndrome) leads to death in 20 to 40% of patients. Pancreas and biliary duct disorders can present as low chest pain, as well as some colitis, especially when associated with colonic interposition between the liver and the diaphragm, the so-called Chilaiditi syndrome.

A rare case of oesophageal rupture: Boerhaave's syndrome.

A 70-year-old patient was referred to our emergency department with severe retrosternal pain after forceful vomiting. Computed tomography (CT) scan revealed a left-sided oesophageal rupture with accompanying pneumomediastinum and bilateral pleural effusions. Conservative treatment with cessation of oral intake, intravenous broad-spectrum antibiotics, parenteral fluids and nutrition and left sided tube thoracostomy was initiated initially. After 5 days, however, the patient deteriorated. Follow-up CT scan demonstrated a mediastinal fluid collection as well as loculated pleural empyema. Open thoracotomy with mediastinal debridement and pleural drainage was performed, after which he made a slow but full recovery. Spontaneous oesophageal rupture due to an abrupt rise in intraluminal pressure caused by vomiting is also known as Boerhaave's syndrome. It is a rare but potentially life-threatening condition. Many patients present with atypical symptoms, and therefore, physicians should have a high index of suspicion in any patient presenting with vomiting and retrosternal pain. When Boerhaave's syndrome is suspected, a CT scan of the thorax and upper abdomen should be performed since treatment depends on clinical and radiological findings. Conservative management (cessation of oral intake, nasogastric decompression, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum antibiotics and proton pump inhibitors and tube thoracostomies) may only be considered in patients with a contained rupture without systematic symptoms of infection. In these patients, endoscopic bridging of the tear with a self-expandable stent is also an option. Primary surgical repair (either by thoracotomy or by video assisted thoracoscopy (VATS)) should be considered when patients present with sepsis and/or large non-contained leaks or with severe mediastinal decontamination.

Successful endoscopic closure of spontaneous esophageal rupture (Boerhaave syndrome)

A 51-year-old man was admitted with severe respiratory distress after spontaneous esophageal rupture after vomiting. The patient was considered too medically unstable to undergo open thoracotomy. EGD was performed (Fig. 1; Video 1, available online at www.giejournal.org), which revealed a 6-cm long complete rupture of the distal esophageal wall. Two over-the-endoscope clips (OVESCO, Tübingen, Germany) were used to approximate the sides of the defect. A fully covered 8-cm long, 24-mm central/32-mm shoulder diameter colonic stent (Hanaro; M.I.

Esophageal rupture as a primary manifestation in eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave's syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

第13病日に手術を施行した特発性食道破裂の1救命例

特発性食道破裂は，迅速な診断と治療が予後に影響する緊急性の高い疾患である．今回われわれは，急性膿胸と診断され保存的治療が行われた後に手術を施行した特発性食道破裂の1例を経験した．症例は73歳，男性．自宅にて嘔吐後に，胸痛・呼吸困難が続いたため，当院へ救急搬送となった．胸部X線検査にて左気胸・胸水を認め，胸腔ドレーンを挿入した．急性膿胸の診断で胸腔洗浄を開始した際，食物残渣の混入を認めた．食道造影では胸部下部食道左壁より造影剤の漏出を認めた．内視鏡検査では破裂部位は胸腔内が観察し得る大きな裂創となっており，ドレナージ不良な大きな膿瘍腔が確認された．第13病日に左開胸食道破裂部縫合閉鎖・胃底部縫着術を施行，術後30日で軽快退院となった．特発性食道破裂は，保存的治療が困難と判断された際には発症から時間が経過していても手術を考慮する必要があり，縫合およびドレナージ法の工夫を要すと考えられた．

胸腔鏡補助下に前側方開胸で治療した特発性食道破裂の検討

要旨 我々は，2008 年12 月から2012 年10 月までに4 例の特発性食道破裂を経験した．すべての症例を右半側臥位で胸腔鏡補助下に前側方開胸のアプローチで手術をした．1 例を除いて，術中に右側にも胸腔ドレーンを挿入した．周術期には，すべての症例で術中からシベレスタットを，また1 例ではさらに術後にカルペリチドを使用した．全症例を安全に手術でき良好な転帰をとった．右半側臥位での胸腔鏡併用，前側方開胸は良好な手術野と手術時間の短縮に寄与すると考えられた．また，シベレスタットの使用や対側胸腔ドレナージの挿入は，高度な侵襲からの早期回復をはかるために有用な方法と考えられた．

Diagnosis and treatment of patients with esophageal perforation and rupture

We retrospectively analyzed the clinical data of 17 patients with esophageal perforation and rupture from August 2007 to December 2011. Among them, there were spontaneous esophageal rupture (n=6), esophageal perforation caused by foreign bodies (n=8) and iatrogenic injury (n=3). Family members gave up treatment because of critical illness (n=2), conservative treatment was offered for surgical intolerance (n=1) and all others (n=14) underwent operation (thoractomy, n=13; neck incision, n=1). One patient with conservative treatment and another two surgical cases died. The other 12 cases recovered. Therefore individualized treatment is essential for the patients with esophageal perforation and rupture. Key words: Esophageal perforation; Esophageal rupture

A rare but important cause of chest pain

Although rare, spontaneous oesophageal rupture is a well described and serious cause of chest pain. Endoscopic intervention should be considered.

Multimodal endoscopic treatment for delayed severe esophageal stricture caused by incomplete stent removal

The usefulness of a covered self-expandable metallic stent for benign esophageal stricture and perforation was well established. In case of benign disease, early stent removal was recommended within 6-8 weeks after placement. A case with severe esophageal stricture caused by incomplete stent removal 7 years after stent placement for spontaneous esophageal rupture was reported. Residual stent fragments could be removed by step-by-step multimodal endoscopic treatment, producing satisfactory luminal diameter of the esophagus. In particular, stent trimming with argon plasma coagulation was safe and effective strategy. The endoscopic stent removal is minimally invasive and should be attempted before surgical intervention; however, it is most important to ensure early stent removal before tissue ingrowth or overgrowth can develop.

Síndrome de Boerhaave: relato de caso

Spontaneous esophageal rupture carries high morbidity and mortality. The main prognostic factor is early diagnosis, before 12 hours, and appropriate treatment. This is a case report of a 41-years-old man with late esophageal rupture diagnosis treated successfully with transmediatinal esophagectomy and esophageal-gastric tube cervical anastomosis.

Recurrent spontaneous esophageal rupture.

Spontaneous rupture of the esophagus is a relatively uncommon event, and recurrent rupture is extremely rare. We present a patient who experienced and survived 2 spontaneous perforations of the esophagus, occurring 6years apart. A 43-year-old man was admitted to our hospital with upper abdominal pain after vomiting. Esophagoscopy, esophagogram, and computed tomography were suggestive of esophageal rupture. Emergency left thoracolaparotomy revealed a 20-mm perforation of the left lower esophageal wall that had been previously repaired. After the perforation was repaired with a single-layer closure, the mediastinum and pleural cavity were drained. The patient recovered well and was discharged from the hospital on postoperative day 29. To the best of our knowledge, only 7 previous cases of recurrent spontaneous esophageal perforation have been reported in the literature.

Medical school finals, nerves and vomiting: Medical student survives Boerhaave’s syndrome with recurrence one week after initial presentation

Boerhaave’s syndrome is a serious condition that can be fatal due to commonly nonspecific symptoms and delayed treatment. This rare syndrome is a result of a spontaneous esophageal rupture. We describe a case of a medical student who developed Boerhaave’s syndrome on the day of his finals. Initially, the medical student’s symptoms were misdiagnosed when they sought medical attention. Despite the medical student being clinically well, their medical knowledge prompted a surgical opinion and Boerhaave’s syndrome was confirmed. Treatment was conservative, however, its recovery was complicated with a recurrence of symptoms shortly after the initial episode. This case highlights and discusses the importance of esophageal rupture to be considered as a cause of chest pain. Prompt diagnosis is of utmost importance. If conservative treatment is commenced, adequate time for healing should be permitted.