Spontaneous Rupture of the Oesophagus: Boerhaaves Syndrome in 2008

Objective: Boerhaave’s syndrome is a spontaneous rupture of the oesophagus with a lack of diagnostic and treatment consistency in the literature. Therefore, we reviewed all published literature in order to design a treatment algorithm based on the literature. Study Design: A systematic literature review written in the English language since 1975. Results: We reviewed all known literature. Treatment of the Boerhaave syndrome was divided into three categories: conservative, endoscopic and surgical approach. The survival rate of all treatments was 75, 100 and 81%, respectively. Conclusion: Boerhaave’s syndrome should be treated endoscopically when diagnosed within 48 h and when there are no signs of sepsis. However, when a patient is diagnosed within 48 h and has a septic profile, thoracotomy with hemifundoplication and pleural/mediastinal drainage should be performed; and in case of intra-abdominal leakage, a laparotomy for local repair should be performed. When a patient is diagnosed after 48 h, conservative treatment should be followed and only when a patient gets a septic profile is surgical treatment indicated. Copyright © 2009 S. Karger AG, Basel Published online: January 15, 2009 Albert Pull ter Gunne St. Elisabeth Hospital, Hilvarenbeekseweg 60 Postbus 90151, NL–5022 Tilburg GC (The Netherlands) Tel. +31 6 1479 8525, Fax +31 8474 61378 E-Mail [email protected] or [email protected] © 2009 S. Karger AG, Basel 0253–4886/09/0261–0001$26.00/0 Accessible online at: www.karger.com/dsu D ow nl oa de d by : 54 .7 0. 40 .1 1 10 /5 /2 01 7 7: 29 :2 0 P M de Schipper/Pull ter Gunne/Oostvogel/ van Laarhoven Dig Surg 2009;26:1–6 2 and pancreatitis [7, 8] . Diagnosis can be made earlier and more accurate with additional radiological examinations such as CT scan [9] ( fig. 2, 3 ). Multiple treatment modalities are described, ranging from conservative measures to extensive surgery. However, no consensus exits about preferred treatment for a spontaneous rupture of the oesophagus. A systematic literature review is performed to detect the best possible treatment strategies. Based on available literature, a treatment algorithm is formed, describing timing and place of conservative, endoscopic and operative treatment. Methods A systematic literature search was performed in PubMed searching for English literature available since 1975. The search was performed on mesh terms ‘spontaneous rupture’, ‘oesophagus’ and ‘treatment’. Since the absence of any level 1 or 2 studies, we included all multi-patient level 3, 4 and 5 articles containing the word ‘Boerhaave’ in the title. All related articles were examined. All articles concerning diagnosis and treatment of Boerhaave’s syndrome were included. Articles concerning treatment of Boerhaave’s syndrome and non-Boerhaave’s syndrome oesophagus perforations were included. In these studies, patient data about true Boerhaave’s syndrome were analysed. The main outcome criterion of all studies was survival.