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Case Reports

Boerhaave Syndrome Treated Conservatively Following Early Endoscopic Diagnosis: A Case Report

Akihisa Matsuda, Masao Miyashita, Koji Sasajima, Tsutomu Nomura, Hiroshi Makino, Takeshi Matsutani, Akira Katsuno, Junpei Sasaki, Takashi Tajiri

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Akihisa Matsuda
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Masao Miyashita
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Koji Sasajima
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Tsutomu Nomura
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Hiroshi Makino
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Takeshi Matsutani
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Akira Katsuno
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Junpei Sasaki
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine
Takashi Tajiri
Surgery for Organ Function and Biological Regulation (Department of Surgery), Nippon Medical School Graduate School of Medicine

Corresponding author

Keywords:Boerhaave syndrome,esophageal rupture,conservative therapy,endoscopy

JOURNALFREE ACCESS

2006 Volume 73Issue 6Pages 341-345

DOIhttps://doi.org/10.1272/jnms.73.341

Details

Published: 2006Received: September 11, 2006Available on J-STAGE: January 11, 2007Accepted: October 25, 2006Advance online publication: -Revised: -

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Abstract

We report on a 41-year-old man with hematemesis and severe epigastric pain. Three hours after the onset of symptoms, we carefully performed upper gastrointestinal endoscopy for suspected upper gastrointestinal perforation. Endoscopy revealed a 2.5-cm-long longitudinal laceration of the lower esophagus without active gastric or duodenal ulcers. The laceration could be partially closed with endoscopic clipping. Computed tomography of the chest revealed a small amount of extraluminal air in the mediastinum. Neither pleural effusion nor pneumothorax was detected. We treated the patient conservatively on the basis of the following factors: a stable general condition without sepsis, limitation of the esophageal disruption to the mediastinum, and early diagnosis. The treatment course was uneventful, and the patient was discharged from the hospital after we had confirmed with endoscopy that the esophageal ulcer was completely healed. Although Boerhaave syndrome is generally considered to have poor prognosis, conservative therapy may be effective in select cases with early detection of the perforation.

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