Boerhaave syndrome, a spontaneous rupture of the esophagus, is a rare but potentially fatal condition. Unfortunately, due to the non-specific symptoms that may be suggested, among others, by myocardial infarction, its early diagnosis is not always possible, which significantly reduces the chances of survival of the patient. What are the causes and symptoms of Boerhaave syndrome? What is the treatment of a spontaneously ruptured esophagus?

Contents:

  1. Boerhaave syndrome - causes
  2. Boerhaave syndrome - symptoms
  3. Boerhaave syndrome - diagnosis
  4. Boerhaave syndrome - treatment
  5. Boerhaave syndrome - prognosis
  6. Esophagus rupture - other causes

Boerhaave syndromeis otherwisespontaneous esophageal rupture , i.e. one that occurs in a he althy esophageal wall and is not caused by mechanical or thermal trauma .

Spontaneous ruptures of the esophagus most often affect men aged 40-60 years.

The mechanism of the injury is a sudden increase in pressure in the lumen of the esophagus as a result of violent vomiting. The rupture most often occurs in the left posterolateral part of the esophagus or, less frequently, in the sub-diaphragmatic area.

Esophagus rupture is a life-threatening condition

Very often, following a rupture of the esophagus, an infection quickly develops and appears

  • mediastinitis
  • pneumonia
  • pleurisy
  • pericarditis
  • pleural abscess

and each of these diseases can lead tosepsis , i.e. general infection of the whole organism.

Boerhaave syndrome - causes

Spontaneous rupture of the esophagus most often occurs after heavy meals and alcohol abuse, and its direct cause is vomiting, which is also a symptom of esophageal rupture.

Boerhaave syndrome - symptoms

The most characteristic of this disease is the so-called Meckler's triad, consisting of:

  • vomiting
  • chest pain, often radiating to the spine and back
  • subcutaneous emphysema (it is observed only in about 30% of patients)

Sometimes a Hamman symptom can be found, i.e. crackling in the upper roadssimultaneous with the heart rate, which is caused by a pneumothorax (it is the result of air entering the mediastinum).

In addition, the following may appear:

  • shortness of breath
  • shock
  • pressure soreness
  • epigastric muscle defense

Boerhaave syndrome - diagnosis

The diagnosis of spontaneous esophageal rupture is usually based on a chest X-ray showing fluid and / or air in the pleural cavity and pneumothorax.

When the X-ray does not allow a definitive diagnosis, endoscopy of the esophagus is performed.

Boerhaave syndrome - treatment

In the case of spontaneous esophageal rupture, surgical or endoscopic treatment is used. The method of treatment depends on the time from the rupture, the degree of infection in the pleural cavity, the length and location of the esophageal wall damage and the condition of the esophageal wall in the area of ​​the perforation:

  • new rupture of the esophagus (up to 24 hours) - suturing the puncture site and drainage of the mediastinum and pleural cavity are used. For an early diagnosis of an esophageal rupture not exceeding 2 cm in length, it is also possible to attach metal clips
  • advanced cases require temporary shutdown of the esophagus with formation of a salivary fistula or esophageal resection
  • in the case of late diagnosis (or a condition that prevents surgical treatment), it is recommended to drain the infected area with the insertion of a self-expanding prosthesis into the esophagus

Treatment with endoscopic methods is recommended mainly in iatrogenic lesions (resulting from doctor's error) of the esophagus, and also in the case of very late diagnosis. In addition, parenteral nutrition and antibiotic therapy (to prevent mediastinitis and sepsis) are also necessary.

Boerhaave syndrome - prognosis

The risk of death after spontaneous rupture of the esophagus is quite high. However, it all depends on the time between esophageal rupture and diagnosis. In case of diagnosis up to 12 hours. from rupture of the esophagus, the mortality rate is 30-40%. Diagnosis established>24 hours from perforation of the esophagus causes an increase in mortality to 50%, while>48 hours. from perforation to approx. 90%

Esophagus rupture - other causes

Spontaneous fracture accounts for approx. 10-15 percent. any perforation in the esophagus. The most common causes of esophageal rupture are:

  • so-called iatrogenic damage: mechanical damage during endoscopic diagnostic and surgical examinations (catheterization,expanding the esophagus, stopping bleeding, tracheal intubation, esophageal prosthesis) and injuries during surgical procedures (spinal cord surgery, hiatal hernia, thoracotomy),
  • chemical damage (bases, acids),
  • mechanical injuries (foreign bodies, blunt injuries, traffic accidents),
  • radiological damage (radiotherapy, radio ablation).

Read also:

  • Esophagus: structure, functions, diseases
  • Esophageal Achalasia: Causes, Symptoms and Treatment of Esophageal Stricture
  • Eosinophilic esophagitis: causes, symptoms, treatment
About the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

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Category:

Gastrology