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Endoscopic treatment of Boerhaave Syndrome: A surprisingly quick healing
Karagiannis Dimitrios, Sakizlis Georgios.
Gastroenterology and Hepatology department.
Boerhaave syndrome has an estimated mortality rate of 20% to 40%. The standard of care is multidisciplinary: surgical, endoscopic or conservative approaches are acceptable.
No consensus exist regarding the best strategy.
Endoscopic treatment consists of closure with endoscopic clips – the through the scope (TTS) clip and the over the scope clip (OTSC), or stenting with removable stents.
This paper explores the case of a spontaneous esophageal rupture after vomiting, which was treated with TTS clips. We note the extremely fast rate of healing of the wound.
Case description.
A 48 year-old male was presented at the emergency room complaining of severe chest pain, which began after several episodes of vomiting, following a meal.
Upon his arrival a severe episode of hematemesis was reported. The electrocardiogram showed tachycardia with a ventricular rate of 128 bpm. The computed tomography of the chest demonstrated a hydrothorax, as well as mediastinal free air. Due to the hemorrhage we performed an emergency upper endoscopy after we obtained the patient’s consent.
We observed an esophageal opening, 11cm long, with a Mallory – Weis tear at the distal end (Figure 1,2).
We clipped the visible vessel and decided to close the opening with clips (Figure 3,4). We used twelve clips and successfully stopped the bleeding while also closing the esophageal opening. Thoracic surgeons placed a thoracic drainage tube. The patient received a conservative therapy, complemented by a withdrawal of oral intake and administration of broad spectrum antibiotics.
The next day we performed a follow up upper endoscopy to inspect the closure and hemostasis. We observed an amazing healing (Figure 5). The chest tube was removed at the fourth day and the patient started oral feeding on the sixth day. The patient was discharged from the hospital with no complications on the eight day (Figure 6). We performed an upper endoscopy after one month with no strictures.
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Figure 5
Figure 1
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1. Successful endoscopic closure of spontaneous esophageal rupture (Boerhaave syndrome).
AUVan Weyenberg SJ, Stam FJ, Marsman W. Gastrointest Endosc Jul;80(1):162. Epub 2014 May 15.
2. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations.Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, Epanomeritakis E. Ann Surg May;259(5):
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Figure 6