ABSTRACT

Boerhaave’s syndrome is esophageal rupture as a result of forceful vomiting or retching against a closed cricopharyngeus. We presented an unusual presentation of Boerhaave Syndrome and discussed its surgical and endoscopic therapy. A seventy one-year-old man had an acute abdomen after forceful vomiting due to esophageal rupture and was brought to the Emergency Clinic of a private hospital in Samsun. He had undergone laparotomy with a repair of the esophageal perforation and feeding jejunostomy. In the postoperative 6 th day, pleural abscess had developed and a right chest tube had been inserted. An esophageal fistula had developed. After he had been transfered to our Clinic, with further investigations using esophagography, tomography and endoscopy, the site of esophageal fistula was established. A “Covered Stent” was inserted and placed over the 3 cm large fistula orifice in the lower part of the esophagus. Control esophagography revealed that the leakage had stopped. After oral feeding the patient had distention and signs of intestinal obstruction. Laparotomy was done and a jejunal torsion was found and revised and the feeding jejunostomy closed. After 6 weeks of insertion, the stent was removed. Control esophagography was normal and oral feeding was started. Boerhaave’s syndrome could be a complication of pre-existent gastrointestinal disease, as in our case. Early diagnosis and carefully selected therapeutic practice can reduce the mortality rate of Boerhaave’s syndrome to an acceptably low level.

Keywords: Boerhaave syndrome, covered stent, esophagography, feeding jejunostomi