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 Table of Contents     
LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 1  |  Page : 25
 

Boerhaave syndrome


Ronak Endo-laparoscopy and General Surgical Hospital, Patan, Gujarat, India

Date of Web Publication13-Jan-2012

Correspondence Address:
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan 384 265, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.91780

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How to cite this article:
Yagnik VD. Boerhaave syndrome. J Min Access Surg 2012;8:25

How to cite this URL:
Yagnik VD. Boerhaave syndrome. J Min Access Surg [serial online] 2012 [cited 2020 Nov 27];8:25. Available from: https://www.journalofmas.com/text.asp?2012/8/1/25/91780


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 Top

1.Vaidya S, Prabhudessai S, Jhawar N, Patankar RV. Boerhaave's syndrome: Thoracolaparoscopic approach. J Minim Access Surg 2010;6:76-9.  Back to cited text no. 1
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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.  Back to cited text no. 2
[PUBMED]    
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.  Back to cited text no. 3
    
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.  Back to cited text no. 4
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