Original Articles
Primary esophageal repair for Boerhaave’s syndrome

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Abstract

Background. Boerhaave’s syndrome is the most sinister cause of esophageal perforation. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated.

Methods. We present a series of 21 patients seen in our unit in the 10 years 1987 to 1996. Esophageal repair was performed in 17 (81%) of them. After the resuscitation of the patient in the intensive care unit, our strategy is primary esophageal repair with a single layer of interrupted absorbable sutures combined with mediastinal toilet, mediastinal drainage, and drainage gastrostomy. The majority of patients (12/21) were referred more than 24 hours after perforation.

Results. The mean age of the patients was 60 ± 17 years. The mean stay in the intensive care unit was 1.6 ± 1.8 days and the median hospital stay, 14 days. There were three deaths, an overall mortality rate of 14.3%.

Conclusions. When combined with mediastinal toilet, mediastinal drainage, and drainage gastrostomy, primary esophageal repair for Boerhaave’s syndrome gives an acceptable mortality and should not be reserved for patients seen within 24 hours after spontaneous rupture.

Section snippets

Material and methods

Twenty-one patients with Boerhaave’s syndrome were treated in our unit between January 1987 and December 1996. There was a clear history of forcible vomiting preceding the onset of symptoms in 18 of these patients. Although the other 3 patients did not describe forcible vomiting, there was no history of esophageal instrumentation, foreign-body ingestion, or trauma. Case notes were reviewed retrospectively. All patients were resuscitated in the intensive care unit after admission, and the site

Results

The mean age of the patients in this series was 60 ± 17 years. The mean stay in the intensive care unit was 1.6 ± 1.8 days, and the median hospital stay was 14 days (range, 3 to 183 days). Nine patients were referred within 24 hours after perforation; there were two deaths in this group. One of the 12 patients seen more than 24 hours after perforation died. The overall mortality rate was 14.3%, and all three deaths occurred in group 2 (Table 1).

Comment

Boerhaave’s syndrome accounts for 30% to 40% of all cases of esophageal perforation. Esophageal perforation is associated with high morbidity and mortality because the anatomic location of the organ predisposes patients to the development of fatal mediastinitis and multisystem organ failure [5]. Esophageal perforation is also associated with a costly hospital stay. Approximately 30 cases of spontaneous esophageal rupture are reported to the United Kingdom Thoracic Registry each year.

The

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