Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases

ABSTRACT

BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition. METHODS: We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea. RESULTS: The results of the clinical reviews are as follows There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms). CONCLUSIONS: We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.