| Theme |
Lesions of Esophagogastric Junction -- Its Diagnostic and Therapeutic Strategies |
| Title |
Boerhaave Syndrome -- Current Concepts and Strategies |
| Author |
Soichi Tomimatsu |
Department of Surgery, Japan Self Defense Force Central Hospital |
| Author |
Hideto Ito |
Department of Surgery, Japan Self Defense Force Central Hospital |
| Author |
Toshiyuki Suganuma |
Department of Surgery, Japan Self Defense Force Central Hospital |
| Author |
Kazuo Hase |
Department of Surgery, Japan Self Defense Force Central Hospital |
| Author |
Takashi Ichikura |
First Department of Surgery, National Defense Medical College |
| Author |
Hidetaka Mochizuki |
First Department of Surgery, National Defense Medical College |
| [ Summary ] |
We described a patient with a spontaneous esophageal rupture (Boerhaave syndrome), and discussed the diagnostic and therapeutic aspects of this disease. Boerhaave syndrome is the rather rare condition where a spontaneous rupture usually occurs as a consequence of the emesis strain. Following acute and fulminant chest pain and/or upper abdominal pain after vomiting, dyspnea and cyanosis occur as the typical course of this syndrome, and delay diagnoses or cause misdiagnoses. These are usually caused by a lack of awareness when considering the ramifications of this disease, leading to fatalities. Diagnosis of this condition is confirmed by simple methods, such as chest X-ray examinations that indicate pneumomediastinum, subcutaneous emphysema of the neck, pneumothorax with pleural effusion. Water-soluble contrast studies of the esophagus may reveal mediastinum spillage of the contrast media. Prompt surgical approaches, in cluding primary repair of the esophageal rent (with or without an omentum flap or a fundic patch), mediastinum and intrathoracic toilet, and effective drainage offers the patient the best opportunity for cure. T tube esophageal drainage or esophageal resection with delayed reconstruction is selected if primary repair is impossible. Prompt diagnosis before surgery and progress in perioperative management has improved the prognosis for this syndrome. |