ABSTRACT
Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thorax/diagnostic imaging , Esophageal Diseases , Mediastinal Diseases/surgery , Radiography, Thoracic , Tomography, X-Ray Computed , Retrospective Studies , Endoscopy, Digestive System , Esophagectomy/methods , Delayed Diagnosis , Tertiary Care Centers/statistics & numerical dataABSTRACT
Boerhaave's syndrome, the spontaneous rupture of the esophagus, is associated with a 35% death rate. Perforated esophagus is a surgical emergency; it is the most serious, and frequently the most rapidly lethal, perforation of the gastro-intestinal tract. Three cases of Boerhaave's syndrome are presented, with their variants and resolutions. Treatment and outcome are largely determined by the time of presentation. We reviewed our experience with esophageal perforations to determine the overall mortality and whether the time of presentation should influence management strategy.
Subject(s)
Adult , Aged , Humans , Male , Esophageal Perforation , Mediastinal Diseases , Esophageal Perforation/diagnosis , Esophageal Perforation/surgery , Mediastinal Diseases/diagnosis , Mediastinal Diseases/surgeryABSTRACT
Background: Mediastinal affections are common and encompass a great number of different diagnoses. Objective: To analyze the clinical aspects and the therapeutic response of 114 patients with mediastinal diseases treated at the Thoracic Surgery Department of Santa Casa de São Paulo Hospital, from 1979 and 1997. Method: The patients were grouped according to the benign or malignant nature of the disease, and the two groups were compared regarding gender, age bracket, symptomatology, topography of the lesion, mortality, and response to treatment. Results: Sixty-three patients had neoplasia: 31 benign and 32 malignant. Fifty-one cases were not neoplastic. No difference was found between the groups regarding gender or age bracket. Half of the patients were between 20 and 49 years of age. The anterior mediastinum was the most frequently affected compartment (66 patients), followed by the upper mediastinum (18 patients), the posterior mediastinum (16 patients), and the middle mediastinum (14 patients). The most frequent histological types were: benign thymus diseases (N = 40), mesenchymal tumors (N = 17), lymphomas (N = 15), neural tumors (N = 9), and germ cell tumors (N = 8). Malignant tumors were more frequently symptomatic (91 percent), and benign tumors were more frequent in asymptomatic patients (92 percent). The most frequent symptoms were related to myastenia gravis, followed by dyspnea and chest pain. Weight loss, anorexia and fever were significantly more frequent in patients with malignant neoplasias. Conclusions: Regarding the clinical aspects we can state that benign lesions were predominant, that mediastinal diseases were more prevalent in young adults, and that benign lesions were more frequent in asymptomatic patients. Treatment (clinical/surgical) was effective in most patients, benefiting approximately 90 percent of the patients with benign affections and 45 percent of the patients with malignant tumors. In 73 percent of the benign affections, surgical treatment was capable of achieving the cure. Mortality resulting from complications was 1.75 percent.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Mediastinal Diseases/surgery , Mediastinal Diseases/diagnosis , Aged, 80 and over , Mediastinal Diseases/classification , Mediastinal Diseases/complications , Follow-Up StudiesABSTRACT
Descreve-se o caso de um paciente do sexo masculino, de 84 anos de idade, que apresentou após traumatismo fechado de tórax, um volumoso hematoso de mediastino. No decorrer da evoluçäo verificou-se instabilidade cardíaca pela presença de arritmia importante, além de derrame pleural hemorrágico bilateral e alteraçöes hematológicas que reverteram após o tratamento cirúrgico de drenagem do hematoma por via transestemal mediana. Seis mêses depois o paciente apresenta-se assintomático
Subject(s)
Aged , Humans , Male , Hematoma/etiology , Mediastinal Diseases/etiology , Thoracic Injuries/complications , Hematoma/surgery , Mediastinal Diseases/surgeryABSTRACT
Os tuberculomas säo lesöes produzidas pelo M. tuberculosis, com rara localizaçäo no mediastino (apenas um caso descrito nos últimos 15 anos). Relata-se um caso de tuberculoma de mediastino, associado a uma pneumonia produzida por Pseudomonas aeruginosa. O paciente, masculino, de 35 anos, apresentava no exame radiológico inicial do tórax importante alargamento de mediastino, onde a planigrafia mostrou tratar-se de massas nodulares, fazendo pensar em um possível processo neoplásico de mediastino, em especial um linfoma. Indicou-se, entäo, uma toracotomia com finalidade diagnóstica e possivelmente terapêutica. Durante o ato operatório encontrou-se uma confluência de massas nodulares, cuja biopsia de congelaçäo mostrou tratar-se de tuberculoma de mediastino. Con este achado tomou-se conduta conservadora para o caso e institui-se o clássico esquema tríplice com hidrazida, etambutol e rifampicina. Com a introduçäo desta terapêutica, o paciente apresentou uma rápida regressäo da massa mediastinal e atualmente encontra-se muito bem e fazendo acompanhamento ambulatorial