Boerhaave’s syndrome in general surgery: the realities and prospects

Abstract

Spontaneous rupture of esophagus is a rare condition and is associated with a high mortality. Currently, there is no single approach in diagnosis and treatment of Boerhaave's syndrome. Objective. The aim is to analyze the world literature for seeking the most informative methods for diagnosis of Boerhaave’s syndrome and optimal methods of surgery. Materials and methods. 32 case reports with spontaneous rupture of esophagus in English and Russian articles within the last 10 years (according to “e-library” and “pubmed” databases) were analyzed. In this period we have had experienced the treatment of two patients with spontaneous rupture of esophagus. Results. Pneumohydrothorax in X-ray picture in patients with a short duration and acute attack of the disease with pleuropulmonal shock is an important complex of symptoms of spontaneous rupture of esophagus. In this case, the diagnosis must be confirmed in CT with oral contrast. The study presents the modern possibilities for non-operative management, traditional open surgery and minimally invasive methods. Advantages, disadvantages and indications of different operative approaches for operative treatment were also discussed in the study. Conclusion. It is crucial to diagnose Boerhaave’s syndrome early. CT with oral contrast is the most informative diagnostic method. Nowadays the surgical treatment of Boerhaave’s syndrome includes the early primary surgical repair of esophagus rupture with fundoplication and gastrostomy. Endoscopic techniques for the treatment of Boerhaave’s syndrome are the promising areas in management strategies.