Problematic issues of diagnosis and treatment of Boerhaave’s syndrome

Abstract

Boerhaave’s syndrome is a rare disease with an incidence of 3.1/1,000,000 per year, has a high mortality rate due to late diagnosis and difficulty in treatment. The purpose of the message is to draw the attention of doctors to the variety of clinical manifestations of Boerhaave’s syndrome, which complicates early diagnosis and decision making. Clinical observation of two patients with Boerhaave’s syndrome is presented. One patient was hospitalized 7 hours after the onset of pain in the upper left side, nausea, vomiting. Clinical examination, ultrasound and chest X-ray revealed no pathology. However, after 3 hours, the patient’s condition deteriorated sharply, emphysema of the neck and chest appeared. X-ray revealed left-sided pneumohemothorax. Thoracotomy revealed a 3.5-cm long rupture in the lower third of the esophagus on its left lateral wall, which was sutured. The chest cavity and mediastinum are debrided and drained using tubes. A gastrostomy was formed. The postoperative period was complicated by multiple organ failure and sepsis. Patient was in the intensive care unit for 29 days. The esophageal wound healed on the 46th day and the patient was discharged for outpatient observation. Another patient was hospitalized three hours after onset of illness with a left-sided pneumohemothorax and acute abdomen symptoms. Chest tube on the left was placed and a dark brown liquid released under pressure. The peritonitis clinical symptoms prompted surgeons to perform urgent laparotomy during which no pathology of the abdominal organs was detected. Only after computed tomography, a rupture of the esophagus was diagnosed. As a result of delayed surgery, infection complications and sepsis developed, which led to the patient’s death.