Successful primary repair in a late presentation of Boerhaave’s syndrome. Case report

Abstract

We present a case of Boerhaaves syndrome successfully managed by open transabdominal approach 48 h after the acute event. A 55-year-old female presented with hydropneumothorax, chest pain, dyspnea, vomiting and fever. The urgent radiologic (X-ray, CT) and endoscopic study revealed the large defect of left posterolateral wall of esophagus with extrusion of fluid and gastric contents into the mediastinum and left chest. Emergency intercostal drainage insertion was performed and patient was transferred to our hospital. By open transabdominal approach after the wide sagittal diaphragmotomy the primary repair over the nasogastric tube using simple interrupted sutures (Vicryl 3/0) and partial fundoplication to cover the suture line was performed. Chest drainage tubes was then positioned near and parallel to the repaired esophagus and feeding jejunostomy was then performed for enteral nutrition. On the seventh postoperative day, a gastrografin swallow showed a small leak in the repair site without any collection, which was healed after 1,5 month of conservative treatment. We consider, that proactive surgical approach with primary surgical repair is still possible and feasible option despite the late presentation of Boerhaaves syndrome.