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LETTER TO THE EDITOR |
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| Year : 2012 | Volume
: 8
| Issue : 1 | Page : 25 |
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Boerhaave syndrome
Vipul D Yagnik
Ronak Endo-laparoscopy and General Surgical Hospital, Patan, Gujarat, India
| Date of Web Publication | 13-Jan-2012 |
Correspondence Address:
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan 384 265, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.91780
How to cite this article:
Yagnik VD. Boerhaave syndrome. J Min Access Surg 2012;8:25 |
Dear Sir,
I read an article by Vaidya et al., [1] with great interest. Boerhaave syndrome accounts for 15% of all traumatic perforation of esophagus. Esophageal perforation has the worst prognosis among all gastrointestinal tract perforation. I would like to add some interesting information which you may find useful. In addition to a sharp increase in intraluminal pressure against closed cricopharyngeus, abnormal esophageal mucosa (reflux esophagitis, Barrett's esophagitis, etc.) and lack of muscularis mucosa [2] may also predispose to perforation. In this case, water-soluble contrast showed leak in the pleural cavity. I recommend barium as a contrast agent of choice in the case of suspected lower esophageal perforation above the gastroesophageal junction as barium is inert in the chest and aspiration of gastrograffin (water-soluble contrast) can cause severe life-threatening pneumonitis. I would recommend water-soluble contrast for suspected intraabdominal esophageal perforation as barium will lead to severe barium peritonitis. The use of barium is associated with a higher detection rate for esophageal perforation. The 22% of the patients who had a normal study with water-soluble contrast, a perforation was detected subsequently with the use of barium. [3] Flexible esophagoscopy can be performed with 100% sensitivity and 80% specificity in those who require operative intervention. The authors have mentioned that urgent surgical management is indicated in all patients. [1] I would like to state here that although standard of care is surgical intervention in most cases, Cameron et al. [4] proposed three criteria in which nonoperative management might be appropriate: (1) disruption contained in the mediastinum, (2) cavity well drain back into esophagus, and (3) minimal sign and symptoms of sepsis.
| ¤ References | |  |
| 1. | Vaidya S, Prabhudessai S, Jhawar N, Patankar RV. Boerhaave's syndrome: Thoracolaparoscopic approach. J Minim Access Surg 2010;6:76-9. 
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| 2. | Kuwano H, Matsumata T, Adachi E, Ohno S, Matsuda H, Mori M, et al. Lack of muscularis mucosa and the occurrence of Boerhaave's syndrome. Am J Surg 1989;158:420-2.
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| 3. | Buecker Anone, Wein BBnone, Neuerburg JMnone, Guenther RWnone. Esophageal perforation: Comparison of use of aqueous and barium-containing contrast media. Radiologynone 1997;202:683-6.
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| 4. | Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Baker RR. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 1979;27:404-8.
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