J Korean Surg Soc.  1999 Aug;57(2):210-216.

Spontaneous Rupture of the Esophagus (Boerhaave's Syndrome): A review of 10 cases

Affiliations
  • 1Department of Surgery, College of Medicine, The Catholic University of Korea.
  • 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea.

Abstract

BACKGROUND: Boerhaave's syndrome is a spontaneous rupture of the esophagus. The classic symptom triad, vomiting, chest pain, and subcutaneous emphysema, rarely develop together. It is diagnosed by using plain chest film, an esophagogram with a water soluble contrast media, and computerized tomography, but it is somewhat difficult to make an early diagnosis. It is generally treated with a surgical procedure, but the most frequent complication is suture line leakage, which leads to a pyothorax, pneumonia, mediastinitis, and eventually an irreversible septic condition.
METHODS
We retrospectively reviewed 10 cases of patients with spontaneous esophageal rupture treated by various surgical methods during the recent 6 years at the Department of Surgery and Internal Medicine, the Catholic University of Korea.
RESULTS
The results of the clinical reviews are as follows: There were 9 males and 1 female, and the mean age was 53 years old. The main symptom was chest pain (70%), and that developed after severe vomiting in 6 cases (60%). Abnormal findings were revealed on the chest PA films of 6 cases. Esophagogram were used in 8 cases, and a combined chest CT in 5 cases. Seven (70%) received an operation in less than 24 hours after the attack and 3 cases after 72 hours. The lower one-third of the esophagus was perforated in 9 cases (90%), and the left side of the esophagus was perforated in 8 cases (80%). The methods of operation were primary repair (6 cases), an esophagectomy and esophagogastrostomy (3 cases), and a cardial ligation, proximal esophagostomy, gastrostomy, and feeding jejunostomy (1 case). Anastomosis leakage and empyema developed in each of 4 cases. The overall mortality rate was 20%; only two patients died due to a delayed hospital visit (surgery 72 hours after first attack of symptoms).
CONCLUSIONS
We recommand that the most important factor affecting the prognosis for spontaneous rupture of the esophagus is early diagnosis and immediate surgical intervention.

Keyword

Spontaneous esophageal rupture; Boerhaave's syndrome

MeSH Terms

Chest Pain
Contrast Media
Early Diagnosis
Empyema
Empyema, Pleural
Esophagectomy
Esophagostomy
Esophagus*
Female
Gastrostomy
Humans
Internal Medicine
Jejunostomy
Korea
Ligation
Male
Mediastinitis
Middle Aged
Mortality
Pneumonia
Prognosis
Retrospective Studies
Rupture
Rupture, Spontaneous*
Subcutaneous Emphysema
Sutures
Thorax
Tomography, X-Ray Computed
Vomiting
Contrast Media
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