López GS, Medina BA, Miranda AAP, Fritsche GL

Language: Spanish
References: 17
Page: 33-38
PDF size: 160.71 Kb.

ABSTRACT

Objective: To present the case of a patient with Boerhaave syndrome managed with minimally invasive surgery.
Introduction: Spontaneous esophageal perforation was first described by Boerhaave in 1724 in a post mortem report. This entity presents posterior to one or several episodes of vomit, always in the absence of an instrumented procedure or external trauma.
Case presentation: We describe the case of a male patient, age 77, who comes to the emergency room with an episode of vomiting 12 hours before attention was received and dyspnea of 6 hours after that. We admit the patient and we take a chest radiography finding a right pleural effusion and air-water levels. We do a blue metilene test, finding a leak through the pleurostomy tube, so we carry out a contrast radiography with water soluble contrast, finding an esophageal perforation in the gastroesophageal junction, so we take the patient to the operating room where it is managed with minimally invasive surgery, making a primary closure and funduplicature. Finally the patient died within 24 days of his admission because respiratory complications.
Conclusions: Spontaneous esophageal perforation is a rare entity where the diagnostic is almost always late, and mortality is high. We consider that the advantages of minimally invasive surgery in esophageal surgery, previously demonstrated in others pathologies, can be offered in the treatment of this disease, however more investigations need to be made about it.

REFERENCES

1. Lama TA, Wijngaarden. Boerhaave. Boerhaave: una mente brillante, un carácter virtuoso. Rev Méd Chile 2002; 130: 1067-1072.

2. Braghetto MI, Rodríguez NA, Csendes JA, Korn BO. Perforación esofágica. Experiencia clínica y actualización del tema. Rev Méd Chile 2005; 133: 1233-1241.

3. Vial CM, Whyte RI. Boerhaave’s Syndrome: Diagnosis and Treatment. Surg Clin N Am 2005; 85: 515–524.

4. Mohan GN, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004; 187: 58-63.

5. Martínez-Ordaz J, Cornejo-López, Blanco-Benavides, Blanco-Benavides R. Síndrome de Boerhaave. Reporte de un caso y revisión de la literatura. Rev Gastroenterol Mex 2002; 67: 190-194.

6. Vogel SB, Rout RW, Martin TD, Abbitt. Esophageal perforation in adults; aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 2005; 241: 1016-1023.

7. Noriega-Maldonado O, Guevara-Torres L, Belmares-Taboada J. Perforación esofágica. Cir Ciruj 2005; 73: 431-435.

8. Kiev J, Amendola M, Bouhaidar D, Sandhu BS, Zhao X, Maher J. A management algorithm for esophageal perforation. Am J Surg 2007; 194: 103-106.

9. Rodriguez NA, Barghetto MI, Csendes JA, Díaz JJ, Korn BO, Burdiles PP, Maluenda F. Resultados actuales del manejo de la perforación esofágica. Rev Chil Cir 2004; 56: 539-544.

10. Altorjay Á, Kiss J, Vörös A, Bohák Á. Nonoperative management of esophageal perforations. Ann Surg 1997; 225: 415-421.

11. Richardson DJ. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg 2005; 190: 161-165.

12. Lawrence DR, Ohri SK, Moxon RE et al. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg 1999; 67: 818-20.

13. Port JL, Kent MS, Korst RJ et al. Thoracic esophageal perforations: a decade of experience. Ann Thorac Surg 2003; 75: 1071-4.

14. Draaisma WA, Rijnhart-de Jong HG, Broeders IA, Smout AJ, Furnee EJ, Gooszen HG. Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication. Ann Surg 2006; 244: 34-41.

15. Salminen PT, Hiekkanen HI, Rantala AP, Ovaska JT. Comparison of long-term outcome of laparoscopic and conventional Nissen fundoplication. Ann Surg 2007; 246: 201-206.

16. Rosemurgy A, Villadolid D, Thometz D et al. Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg 2005: 241: 725-735.

17. Smithers MB, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 2007; 245: 232-240.