Journal of Minimal Access Surgery

LETTER TO THE EDITOR
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Year : 2012  |  Volume : 8  |  Issue : 1  |  Page : 25-

Boerhaave syndrome

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

Correspondence Address:
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan 384 265, Gujarat
India




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


How to cite this URL:
Yagnik VD. Boerhaave syndrome. J Min Access Surg [serial online] 2012 [cited 2022 Aug 14 ];8:25-25
Available from: https://www.journalofmas.com/text.asp?2012/8/1/25/91780


Full Text

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

1Vaidya S, Prabhudessai S, Jhawar N, Patankar RV. Boerhaave's syndrome: Thoracolaparoscopic approach. J Minim Access Surg 2010;6:76-9.
2Kuwano 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.
3Buecker Anone, Wein BBnone, Neuerburg JMnone, Guenther RWnone. Esophageal perforation: Comparison of use of aqueous and barium-containing contrast media. Radiologynone 1997;202:683-6.
4Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Baker RR. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 1979;27:404-8.