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Alternative management of delayed spontaneous oesophageal perforation by endoscopic stenting
  1. Christina Zhu1,
  2. Adan Castrodad2 and
  3. Ariel P Santos2
  1. 1Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
  2. 2Department of Surgery, Texas Tech University Health Sciences Center, Covenant Medical Center, Lubbock, TX, USA
  1. Correspondence to Christina Zhu; christina.zhu{at}ttuhsc.edu

Abstract

Boerhaave’s syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%–50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave’s syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.

  • cardiothoracic surgery
  • empyema
  • oesophagus
  • GI stents

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Footnotes

  • Twitter @tinazhu_, @traumamd1

  • Contributors CZ: data collection and collation and manuscript drafting and reviewing. AC: data collection and manuscript drafting. APS: concept, manuscript reviewing and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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