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Third time recurrent Boerhaave’s syndrome: a case report

BACKGROUND: Effort rupture of the esophagus or Boerhaave’s syndrome is a rare entity, and prognosis is largely dependent on early diagnosis and treatment. Recurrent effort ruptures are very rare, only reported in a few case reports in English literature. We present a case with a third time effort ru...

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Autores principales: Zeyara, Adam, Jeremiasen, Martin, Åkesson, Oscar, Falkenback, Dan, Hermansson, Michael, Johansson, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088656/
https://www.ncbi.nlm.nih.gov/pubmed/33933141
http://dx.doi.org/10.1186/s13256-021-02779-5
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author Zeyara, Adam
Jeremiasen, Martin
Åkesson, Oscar
Falkenback, Dan
Hermansson, Michael
Johansson, Jan
author_facet Zeyara, Adam
Jeremiasen, Martin
Åkesson, Oscar
Falkenback, Dan
Hermansson, Michael
Johansson, Jan
author_sort Zeyara, Adam
collection PubMed
description BACKGROUND: Effort rupture of the esophagus or Boerhaave’s syndrome is a rare entity, and prognosis is largely dependent on early diagnosis and treatment. Recurrent effort ruptures are very rare, only reported in a few case reports in English literature. We present a case with a third time effort rupture, and to the best of our knowledge there are no such previous publications. Furthermore, the presented case is also distinct because each episode was treated by different methods, reflecting the pathophysiology of recurrent disease as well as the last decade’s advancements in the management of esophageal perforations in our clinic and globally. CASE PRESENTATION: The patient is a 60-year-old White male, suffering from alcohol abuse, mild reflux esophagitis, and a history of effort esophageal ruptures on two previous occasions. He was now admitted to our ward once again because of a third bout of Boerhaave’s syndrome. The first time, 10 years ago, he was managed by thoracotomy and laparotomy with primary repair, and the second time, 5 years ago, by transhiatal mediastinal drainage through a laparotomy and endoscopic stent placement. Now he was successfully managed by endovascular vacuum-assisted closure therapy alone. CONCLUSIONS: Recurrent cases of Boerhaave’s syndrome are very rare, and treatment must be tailored individually. The basic rationale is, however, no different from primary disease: (1) early diagnosis, (2) adequate drainage of extraesophageal contamination, and (3) restoration of esophageal integrity. Recurrent disease is usually contained and exceptionally suitable for primary endoscopic treatment. To cover the full panorama and difficult nature of complex esophageal disease, endoscopic modalities such as stent placement and endovascular vacuum-assisted closure, as well as the capacity for prompt extensive surgical interventions such as esophagectomy, should be readily accessible within every modern esophageal center.
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spelling pubmed-80886562021-05-03 Third time recurrent Boerhaave’s syndrome: a case report Zeyara, Adam Jeremiasen, Martin Åkesson, Oscar Falkenback, Dan Hermansson, Michael Johansson, Jan J Med Case Rep Case Report BACKGROUND: Effort rupture of the esophagus or Boerhaave’s syndrome is a rare entity, and prognosis is largely dependent on early diagnosis and treatment. Recurrent effort ruptures are very rare, only reported in a few case reports in English literature. We present a case with a third time effort rupture, and to the best of our knowledge there are no such previous publications. Furthermore, the presented case is also distinct because each episode was treated by different methods, reflecting the pathophysiology of recurrent disease as well as the last decade’s advancements in the management of esophageal perforations in our clinic and globally. CASE PRESENTATION: The patient is a 60-year-old White male, suffering from alcohol abuse, mild reflux esophagitis, and a history of effort esophageal ruptures on two previous occasions. He was now admitted to our ward once again because of a third bout of Boerhaave’s syndrome. The first time, 10 years ago, he was managed by thoracotomy and laparotomy with primary repair, and the second time, 5 years ago, by transhiatal mediastinal drainage through a laparotomy and endoscopic stent placement. Now he was successfully managed by endovascular vacuum-assisted closure therapy alone. CONCLUSIONS: Recurrent cases of Boerhaave’s syndrome are very rare, and treatment must be tailored individually. The basic rationale is, however, no different from primary disease: (1) early diagnosis, (2) adequate drainage of extraesophageal contamination, and (3) restoration of esophageal integrity. Recurrent disease is usually contained and exceptionally suitable for primary endoscopic treatment. To cover the full panorama and difficult nature of complex esophageal disease, endoscopic modalities such as stent placement and endovascular vacuum-assisted closure, as well as the capacity for prompt extensive surgical interventions such as esophagectomy, should be readily accessible within every modern esophageal center. BioMed Central 2021-05-02 /pmc/articles/PMC8088656/ /pubmed/33933141 http://dx.doi.org/10.1186/s13256-021-02779-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Zeyara, Adam
Jeremiasen, Martin
Åkesson, Oscar
Falkenback, Dan
Hermansson, Michael
Johansson, Jan
Third time recurrent Boerhaave’s syndrome: a case report
title Third time recurrent Boerhaave’s syndrome: a case report
title_full Third time recurrent Boerhaave’s syndrome: a case report
title_fullStr Third time recurrent Boerhaave’s syndrome: a case report
title_full_unstemmed Third time recurrent Boerhaave’s syndrome: a case report
title_short Third time recurrent Boerhaave’s syndrome: a case report
title_sort third time recurrent boerhaave’s syndrome: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088656/
https://www.ncbi.nlm.nih.gov/pubmed/33933141
http://dx.doi.org/10.1186/s13256-021-02779-5
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