Management of Boerhaave’s Syndrome
Boerhaave’s syndrome or spontaneous oesophageal perforation is characterised by
barogenic oesophageal injury. This leads to contamination of the pleural cavity with enteric
contents and various degrees of injury.
The syndrome is named after Herman Boerhaave, a Dutch physician,
who first described it in 1724. Incidence of spontaneous rupture amongst all
oesophageal ruptures varies between 15-38%.
Mallory-Weiss tears are assumed to represent part of the spectrum of
the spontaneous perforation, but it is likely that these mucosal injuries
reflect shearing rather than barogenic trauma.
Early diagnosis and definitive surgical management as soon as possible after
the presentation of symptoms, indisputably within the first 24 hours show the best outcomes.
Oral, water-soluble contrast medium is the most used and preferred method of
investigation for visualisation of the oesophageal leak. Although this method helps in revealing
most cases of oesophageal perforation, it may be associated with up to 66% false negative
results and up to 90% sensitivity.
In approximately 90% of the cases, the area of perforation and contrast leak is at the left posterolateral aspect of the distal third of the oesophagus, usually within 2-3 cm above the oesophagogastric junction.
The complication risk of endoscopic assessment is minimal and it excludes the diagnosis if normal.
Apart from showing a leak, it reveals the degree of contamination and associated
extra-oesophageal insult; in addition,
it has a significant role in the decision-making process as well as post-operatively in patient
assessment.
Management of Boerhaave’s Syndrome
Gastro Open J. 2017; 2(1): e1-e3. doi: 10.17140/GOJ-2-e003
