Diaphragmatic pedicled flap for treatment of Boerhaave syndrome

10.17605/OSF.IO/NDK3H

 


Lopez-Jaime CA, Torres-Amaya R, Perzabal-Avilez CT, Salais-Michaus V. Diaphragmatic pedicled flap for treatment of Boerhaave syndrome. Am J Med Surg. 2020; 2(3). 16-20.

From the Division of General surgery and Laparoscopy at Hospital General de Ciudad Juarez, Chihuahua, Mexico. Received on November 15, 2020. Accepted on November 20, 2020. Published on November 23, 2020.

Abstract: Boerhaave syndrome is an uncommon condition comprising spontaneous oesophageal rupture. The annual incidence rate of esophageal perforations is low, approximately 3.1 per 1,000,000 individuals, and 15% of all cases have Boerhaave syndrome.

This is a 50-year-old female with a history of smoking and intense alcoholism, who presented 3 days of nausea and vomiting, with moderate pain in chest and dyspnea. On physical examination, the patient was feverish, hypotensive, sleepy and disoriented, with dehydrated oral mucosa, with tachycardia, decreased vesicular murmur in the bibasal region, rales in the bibasal region, with dullness to percussion in the basal region of both hemithorax, with tachypnea.

A chest radiograph was performed, with evidence of bilateral pleural effusion, laboratories with evidence of leukocytosis, as well as kidney and liver failure. She was admitted to the intensive care unit, a simple chest tomography was performed with the nasogastric tube located to the right of the midline in the chest, with pneumomediastinum.

A left posterolateral thoracotomy is performed in the 6th intercostal space, the necrotic tissue is debrided from the mediastinal fat, from the necrotic muscle tissue and thorough cleaning is performed, a primary closure of the esophagus with a diaphragm flap was performed.

The surgical options are primary closure, reinforced primary closure (intercostal muscle, pleura, diaphragm, stomach, omentum, and lung) and esophageal exclusion or resection.

The mortality rate in esophageal perforation is 10% with early diagnosis and can be as high as 50% if diagnosed late.

 

Keywords: Boerhaave’s syndrome, pneumothorax, esophageal perforation, surgical treatment