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A Journal on Surgery

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Chirurgia 2000 February;13(1):29-34


language: Italian

Spontaneous rupture of the oesophagus (Boerhaave’s syndrome). Report of four cases and observations on etiopathogenesis, physiopathology, clinical aspects and treatment

Leoncini G., Iurilli L., Stella M., Queirolo A., Serrano J., Leoni C., Catrambone G.


Four cases of spontaneous rupture of the oesophagus are presented. The clinical onset, the time interval between presentation and diagnosis, the therapeutical strategy and outcome in these cases are different. Diagnosis was made after 12 hours in two patients, after about 32 hours in one patient and after 6 days in the fourth one. Typical clinical presentation with chest pain, vomitus and subcutaneous emphysema was observed only in one patient. In two cases with early presentation and in the case with a later diagnosis an immediate suturing of the esophageal rupture was performed. In the fourth case pleural and mediastinal ³toilette² was made and a T tube was put into the esophageal rupture. Immediate suturing was successful in one case with early diagnosis and in the case with relatively delayed diagnosis (after 32 hours). A dehiscence of the suture occurred in the second case with early diagnosis. A bipolar esophageal exclusion procedure was performed first, and the esophagectomy afterwards. The patient was discharged in good health. In the fourth case, with very late diagnosis, after the initial improvement of clinical conditions, the patient died because of cardiac failure. Issues concerning differential diagnosis between Boerhaave¹s syndrome and similar and more frequent pathologies are discussed. Moreover, possible therapeutical strategies are analysed, both in case of early and in delayed diagnosis.

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