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Chirurgia 2006 August;19(4):279-83

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: Italian

Conservative treatment of Boerhaave’s Syndro-me in the elderly: case report

Testi W. 1, Voltolini L. 2, Malatesti R. 3, Silverio R. 4, Macchitella Y. 3, De Martino A. 1, Botta G. 3, Consiglio F. M. 1

1 Dipartimento di Chirurgia Generale e Specialistica U.O. Chirurgia Generale III Azienda Ospedaliera Universitaria Senese, Siena 2 Istituto di Chirurgia Toracica Azienda Ospedaliera Universitaria Senese, Siena 3 Dipartimento di Chirurgia Generale e Specialistica U.O. Chirurgia Generale III, Azienda Ospedaliera Universitaria Senese, Siena 4 Struttura Complessa di Radiologia Universitaria Azienda Ospedaliera Universitaria Senese, Siena


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Despite of the important progress in thoracic surgery, the treatment of esophageal perforation remain a discussed and controversial argument. A woman of 83 years old, was admitted to hospital for epigastric pain arised since 24 hours with nausea, emesis and fever. Initially the case was suggesting for a cholecistitis; after four days we assisted to an aggravation of symptomathology associated with cervical emphisema. The thoracic CT response was “a mediastinitis due to a rupture of the esophagus”. Medical treatment was total parenteral nutrition and best performed antibiotic therapy. The patient had a slow improvement until complete recovery. At the beginning, symptomathology was prevalently abdominal (biliary colic and emesis); for this reason, diagnosis was done when mediastinitis was already established and surgical treatment was very dangerous. In conclusion the Boerhaave’s Syndrome is a rare pathology and it can starts with an unclear symptomathology. When diagnosis is late, surgical treatment is extremely dangerous and sometimes, we may obtained good results with conservative therapy.

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