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CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(01): E92-E97
DOI: 10.1055/s-0043-124075
Case report
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Non-surgical management of Boerhaave’s syndrome: a case series study and review of the literature

Khalil Aloreidi
1   Department of Internal Medicine, University of South Dakota – Sanford School of Medicine, Sioux Falls, South Dakota, United States
,
Bhavesh Patel
2   Department of Gastroenterology, University of South Dakota – Sanford School of Medicine, Sioux Falls, South Dakota, United States
,
Tim Ridgway
2   Department of Gastroenterology, University of South Dakota – Sanford School of Medicine, Sioux Falls, South Dakota, United States
,
Terry Yeager
3   Department of Interventional Radiology, University of South Dakota – Sanford School of Medicine, Sioux Falls, South Dakota, United States
,
Muslim Atiq
2   Department of Gastroenterology, University of South Dakota – Sanford School of Medicine, Sioux Falls, South Dakota, United States
› Author Affiliations
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Publication History

submitted 09 June 2017

accepted after revision 31 August 2017

Publication Date:
16 January 2018 (online)

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Abstract

Background and study aims Boerhaave’s syndrome (BS) is a life-threatening condition with morbidity and mortality rates as high as 50 % in some reports. Until recently, surgical intervention has been the mainstay of management plans. With advances in therapeutic endoscopy, however, there has been increasing interest in non-surgical options including endoscopic esophageal stenting.

Patients and methods We reviewed the medical records of all patients diagnosed with BS and managed with endoscopic interventions between November 2011 and November 2016. The following variables were collected: patient demographics, clinical presentations, locations of esophageal perforation, primary interventions, complications, and outcomes.

Results Six patients were found to be diagnosed with BS during the study period. The median age at presentation was 55. There were 4 males and 2 females. The most common site of perforation was in the distal esophagus. The most common presenting symptom was chest pain (67 %) following an episode of vomiting or retching. Four patients (66.7 %) developed septic shock. Endoscopic treatment with a fully covered esophageal stent was the primary intervention in all patients (100 %). Interventional radiology was consulted in all cases for fluid drainage and chest tube placements. Clinical resolution of the BS was achieved in all patients (100 %) without any subsequent surgical interventions. There were no deaths within the study group, and the average follow-up duration was 2 years.

Conclusion Endoscopic treatment seems to be an effective management strategy in patients with BS. We also noted satisfactory results in patients presenting with sepsis, presumably due to urgent, interventional radiology-guided fluid drainage.

 

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