Año 2020 / Volumen 112 / Número 9
Original
Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients

669-674

DOI: 10.17235/reed.2020.6746/2019

Xiao-Liang Yan, Li Jing, Lin-Jing Guo, Yun-Kui Huo, Yong-Cai Zhang, Xiu-Wen Yan, Yong-Zhi Deng,

Resumen
Background: spontaneous esophageal rupture (Boerhaave’s syndrome) is a rare and challenging clinical condition. Objective: to evaluate the outcome of different surgical treatments for patients with Boerhaave’s syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. Patients and methods: eighty-eight patients with Boerhaave’s syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). Results: the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). Conclusions: it is very important to establish an early diagnosis for patients with Boerhaave’s syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1.Biancari F, Saarnio J, Mennander A, et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg 2014;38:902-9. DOI: 10.1007/s00268-013-2312-2
2.Khan AZ, Strauss D, Mason RC. Boerhaave syndrome: diagnosis and surgical management. Surgeon 2007;5:39-44.
3.Biancari F, D’Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 2013;37:1051-9. DOI: 10.1007/s00268-013-1951-7
4.Derbes VJ, Mitchell Jr RE. Hermann Boerhaave’s Atrocis, nec descripti prius, morbi historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc 1955;43:217-40.
5.Sulpice L, Dileon S, Rayar M, et al. Conservative surgical management of Boerhaave's syndrome: experience of two tertiary referral centers. Int J Surg 2013;11:64-7. DOI: 10.1016/j.ijsu.2012.11.013.
6.Teh E, Edwards J, Duffy J, et al. Boerhaave's syndrome: a review of management and outcome. Interact Cardiovasc Thorac Surg 2007;6:640-3. DOI: 10.1510/icvts.2007.151936
7.Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004;77:1475-83. DOI: 10.1016/j.athoracsur.2003.08.037
8.Sdralis EIK, Petousis S, Rashid F, et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus 2017;30:1-6. DOI: 10.1093/dote/dox013
9.Sudarshan M, Elharram M, Spicer J, et al. Management of esophageal perforation in the endoscopic era: Is operative repair still relevant? Surgery 2016;160:1104-10. DOI: 10.1016/j.surg.2016.07.025
10.de Schipper JP, Pull ter Gunne AF, Oostvogel HJ, et al. Spontaneous rupture of the oesophagus: Boerhaave's syndrome in 2008. Literature review and treatment algorithm. Dig Surg 2009;26:1-6. DOI: 10.1159/000191283. Epub 2009 Jan 15
11.Griffin SM, Lamb PJ, Shenfine J, et al. Spontaneous rupture of the oesophagus. Br J Surg 2008;95:1115-20. DOI: 10.1002/bjs.6294
12.Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the frst 24 hours. Scand J Trauma Resusc Emerg Med 2011;19:66. DOI: 10.1186/1757-7241-19-66
13.Valdivielso Cortázar E, Couto Wörner I, Alonso Aguirre P. Endoscopic management of Boerhaave’s síndrome. Rev Esp Enferm Dig 2019;111:493. DOI: 10.17235/reed.2019.6013/2018
14.Barrett NR. Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg 1947;35:216-8. DOI: 10.1002/bjs.18003513821
15.Dasari BV, Neely D, Kennedy A, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg 2014;259:852-60. DOI: 10.1097/SLA.0000000000000564
16.Mackler SA. Spontaneous rupture of the esophagus; an experimental and clinical study. Surg Gynecol Obstet 1952;95:345-56.
17.Lázár G Jr, Paszt A, Simonka Z, et al. A successful strategy for surgical treatment of Boerhaave's syndrome. Surg Endosc 2011;25:3613-9. DOI: 10.1007/s00464-011-1767-1
18.Bayram AS, Erol MM, Melek H, et al. The success of surgery in the frst 24 hours in patients with esophageal perforation. Eurasian J Med 2015;47:41–7. DOI: 10.5152/eajm.2014.55
19.Han D, Huang Z, Xiang J, et al. The role of operation in the treatment of Boerhaave’s syndrome. Biomed Res Int 2018;2018:8483401. DOI: 10.1155/2018/8483401
20.Shen G, Chai Y, Zhang GF. Successful surgical strategy in a late case of Boerhaave's syndrome. World J Gastroenterol 2014;20:12696-700. DOI: 10.3748/wjg.v20.i35.12696
21.Pezzetta E, Kokudo T, Uldry E, et al. The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome)-20 years of experience. Biosci Trends 2016;10:120-4. DOI: 10.5582/bst.2016.01009
22.Hauge T, Kleven OC, Johnson E, et al. Outcome after stenting and débridement for spontaneous esophageal rupture. Scand J Gastroenterol. 2018;53:398-402. DOI: 10.1080/00365521.2018.1448886
23.Glatz T, Marjanovic G, Kulemann B, et al. Management and outcome of esophageal stenting for spontaneous esophageal perforations. Dis Esophagus 2017;30:1-6. DOI: 10.1111/dote.12461
24.Fausto B, Tuomas T, Tatu Y, et al. Outcome of stent grafting for esophageal perforations: single-center experience. Surg Endosc 2017;31:3696-702. DOI: 10.1007/s00464-016-5408-6
25.Nakano T, Onodera K, Ihikawa H, et al. Thoracoscopic primary repair with mediastinal drainage is a viable option for patients with Boerhaave’s syndrome. J Thorac Dis 2018;10:784-9. DOI: 10.21037/jtd.2018.01.50
26.Okamoto H, Onodera K, Kamba R, et al. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018;10:2206-12. DOI: 10.21037/jtd.2018.03.136
Artículos relacionados

Carta

Intestinal obstruction due to pneumatosis intestinalis

DOI: 10.17235/reed.2023.9608/2023

Imagen en Patología Digestiva

An unusual cause of a protuberant lesion of the gastric antrum

DOI: 10.17235/reed.2022.8771/2022

Imagen en Patología Digestiva

Tumor del estroma gastrointestinal gástrico abscesificado

DOI: 10.17235/reed.2022.8580/2022

Revisión

Revisión del diagnóstico y manejo del quiste hidatídico hepático

DOI: 10.17235/reed.2021.7896/2021

Carta

Cirugía radical en hidatidosis hepática

DOI: 10.17235/reed.2021.7743/2020

Imagen en Patología Digestiva

Duodenal diverticulum causing obstructive jaundice – Lemmel’s syndrome

DOI: 10.17235/reed.2020.7516/2020

Carta

Bezoar en hernia de hiato incarcerada y complicada

DOI: 10.17235/reed.2019.6159/2019

Editorial

Safe surgery for cystic tumors of the pancreas

DOI: 10.17235/reed.2019.6042/2018

Carta al Editor

Consecuencias de la lesión de Dieulafoy en cirugía gástrica

DOI: 10.17235/reed.2018.5442/2017

Original

Utilidad del balón intragástrico previo a cirugía bariátrica

DOI: 10.17235/reed.2017.4624/2016

Carta al Editor

Resección endoscópica submucosa transanal (TASER) mediante sistema TEO

DOI: 10.17235/reed.2016.4154/2015

Caso Clínico

Carcinoma epidermoide primario de recto medio: una histología atípica

DOI: 10.17235/reed.2016.3975/2015

Instrucciones para citar
Yan X, Jing L, Guo L, Huo Y, Zhang Y, Yan X, et all. Surgical management of Boerhaave’s syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. 6746/2019


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 1189 veces.
Este artículo ha sido descargado 226 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 15/11/2019

Aceptado: 01/02/2020

Prepublicado: 04/06/2020

Publicado: 10/09/2020

Tiempo de revisión del artículo: 71 días

Tiempo de prepublicación: 202 días

Tiempo de edición del artículo: 300 días


Compartir
Este artículo aun no tiene valoraciones.
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas