Boerhaave’s syndrome: long free interval before successful primary repair Case report

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COD: 399-402 Categorie: ,

Franco Stella, Fabio Davoli, Jury Brandolini, Giampiero Dolci, Alessandro Bini

Ann. Ital. Chir., 2009; 80: 399-402

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AIM: Report case of a 66-year-old man come to our observation for a bilateral pleural effusion, ten days after clinical
manifestations of chest pain, initially misdiagnosed with a myocardial infarction.
MATERIAL OF STUDY: On the same day, the patient underwent an emergency chest CT scan with orally administered
contrast medium that confirmed our suspicion of breakage of the esophageal wall. The patient underwent to a left thoracotomy:
the visceral pleura and all the structures covered by the parietal pleura were affected by a widespread necrotic
process. The subsequent cleansing of the pleural cavity revealed that the distal portion of the thoracic esophagus was
lacerated for about 5 cm; the tear was repaired with continuous reabsorbable sutures; to protect the suture fundoplication
of the gastric fundus was performed.
RESULTS: Post-operative course was complicated on 15th day by a chylous spreading from the chest drains; to complete
the postoperative checks, a chest CT scan was therefore performed, orally administering the contrast medium without any
signs of extraluminal spreading; the chylous effusion resolved spontaneously with diet. After being discharged, the patient
was followed on an outpatient basis for 36 months.
CONCLUSION: Boerhaave’s syndrome is a rare and serious clinical condition; when a patient is diagnosed after 24-48 hs,
many surgeons follow conservative treatment; however primary repair can be safely accomplished regardless of the time
interval between perforation and operation, like our singular experience demonstrated.

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