Against all odds. Conservative management of Boerhaave’s syndrome

Spontaneous oesophageal perforation or Boerhaave's syndrome is a life-threatening condition that usually requires early diagnosis and early surgical management. A 79-year-old man presented to the accident and emergency department with an ischaemic left big toe. He reported a 2-week history of w...

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Bibliographic Details
Published in:BMJ case reports 2014-05, Vol.2014, p.bcr2013200485
Main Authors: Anwuzia-Iwegbu, Charles, Al Omran, Yasser, Heaford, Amelia
Format: Article
Language:English
Subjects:
2-Pyridinylmethylsulfinylbenzimidazoles - therapeutic use
Acute coronary syndromes
Aged
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antifungal Agents - therapeutic use
Drainage
Esophageal Perforation - complications
Esophageal Perforation - therapy
Fluconazole - therapeutic use
Humans
Male
Mediastinal Diseases - complications
Mediastinal Diseases - therapy
Metronidazole - therapeutic use
Mortality
Ostomy
Parenteral Nutrition
Patients
Penicillanic Acid - analogs & derivatives
Penicillanic Acid - therapeutic use
Piperacillin - therapeutic use
Pleural Effusion - etiology
Pleural Effusion - surgery
Proton Pump Inhibitors - therapeutic use
Rare Disease
Sepsis
Studies
Surgery
United Kingdom
White
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Summary:Spontaneous oesophageal perforation or Boerhaave's syndrome is a life-threatening condition that usually requires early diagnosis and early surgical management. A 79-year-old man presented to the accident and emergency department with an ischaemic left big toe. He reported a 2-week history of worsening symptoms and a claudication distance in his left leg of 20–30 m. Three days post-revascularisation of the leg, the patient reported chest pain radiating to the back. CT angiography of the aorta indicated Boerhaave’s syndrome. Following 35 days of conservative management in the intensive care unit and high dependency unit, the patient was stepped down to a surgical ward. A water-soluble contrast study demonstrated minimal leak through the perforated oesophagus. The patient was started on oral intake, which was well tolerated. This case highlights that conservative management may be appropriate.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-200485