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Xiong SY, Liu CJ, Li YF, Zhang HL, Chen XW, Wang HM, Chen JC. Multimodal diagnostic and surgical approach to spontaneous esophageal rupture induced by severe coughing: A case report. World J Gastrointest Surg 2025; 17:101578. [PMID: 40291893 PMCID: PMC12019034 DOI: 10.4240/wjgs.v17.i4.101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 12/10/2024] [Accepted: 02/10/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Boerhaave syndrome, or spontaneous esophageal rupture, is a rare and life-threatening emergency, typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting. Early diagnosis is challenging as its symptoms often resemble those of other diseases. Understanding its pathological features and treatment strategies is therefore critical for clinical practice. CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension. Following severe coughing, the patient developed chest pain, vomiting, and respiratory distress. Initial clinical evaluation was inconclusive, with a suspected diagnosis of cardiovascular or gastrointestinal conditions. After further examination, the diagnosis of spontaneous esophageal rupture was confirmed. Chest X-ray, computed tomography, and endoscopy revealed a rupture in the lower esophagus, along with mediastinal abscess and pleural effusion. Laboratory tests showed mild infection markers. The patient underwent surgical repair of the esophageal rupture (approximately 3 cm in length) with mediastinal drainage. Postoperatively, the patient's temperature normalized within 3 days, respiratory function improved, and pleural effusion significantly decreased. After two weeks of treatment, the patient was discharged without complications and had a favorable prognosis. The study suggests that while violent coughing is a rare trigger, it can lead to severe damage, and imaging techniques play a crucial role in diagnosis. CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial for improving prognosis. This case highlights the importance of imaging and surgical treatment, offering new insights for managing similar cases and providing valuable clinical guidance.
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Affiliation(s)
- Shu-Yun Xiong
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Chang-Jiang Liu
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Yong-Feng Li
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Han-Liang Zhang
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Xiao-Wei Chen
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Hai-Man Wang
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Ji-Cai Chen
- Department of Thoracic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, Guangdong Province, China
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Donado Jimenez MJ, Jimenez MC, Cubas R. Robotic surgery in the management of synchronous esophageal and gastric perforation after endoscopic dilation. BMJ Case Rep 2024; 17:e258060. [PMID: 38216165 PMCID: PMC10806898 DOI: 10.1136/bcr-2023-258060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/14/2024] Open
Abstract
Upper gastrointestinal perforation is a feared complication of diagnostic and therapeutic endoscopy, with an incidence of perforation between 0.3% and 5%. Even though is rare, the mortality rate can be as high as 40%. Currently, there is no consensus on the best therapeutic strategy and it usually depends on patient stability, the extent of perforation, time to diagnosis, surgeon experience and available resourcesWe present a case of a patient who presented to our institution to undergo an ambulatory oesophageal dilation. After dilation, the patient developed two full-thickness gastric perforations and a full-thickness oesophageal perforation without haemodynamic instability. All perforations were diagnosed and treated with a combination of intraoperative endoscopy and robotic surgery with excellent outcomes.We demonstrate that a robotic approach combined with intraoperative diagnostic endoscopy is a safe and feasible treatment option for esophageal and gastric perforations in a stable patient without large extraluminal contamination.
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Affiliation(s)
| | - Maria Carolina Jimenez
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert Cubas
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Samidoust P, Ashoobi MT, Aghajanzadeh M, Delshad MSE, Haghighi M. Boerhaave's syndrome in a patient with achalasia: A rare case report. Int J Surg Case Rep 2023; 106:108183. [PMID: 37120898 PMCID: PMC10173186 DOI: 10.1016/j.ijscr.2023.108183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Boerhaave's syndrome (BS) is a rare spontaneous perforation of the esophagus with a high rate of morbidity that results in death in the case of delayed diagnosis and treatment. Here, we describe a patient with achalasia who was diagnosed with BS. CASE PRESENTATION This present case is a 63-year-old man with a previous history of achalasia and with a complaint of sudden onset of severe right chest pain, epigastric pain, etc. to Razi hospital, Rasht, Iran in March 2022. CLINICAL DISCUSSION Due to the clinical findings of the patients, the diagnosis was BS and the patient's condition was reported to be good at the two-month follow-up. CONCLUSION Early diagnosis of BS results in more effective treatment. Also, stenting is suggested to be effective to reduce the rate of morbidity and mortality in patients with BS.
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Affiliation(s)
- Pirouz Samidoust
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Manouchehr Aghajanzadeh
- Inflammatory Lung Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | | | - Mohammad Haghighi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Correia de Sá T, Silva J, Freitas C. Incarcerated paraoesophageal hernia complicated with distal oesophageal perforation: a combined laparoscopic and endoscopic approach. BMJ Case Rep 2021; 14:14/4/e240780. [PMID: 33849872 PMCID: PMC8051381 DOI: 10.1136/bcr-2020-240780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Paraoesophageal hernias are common, but symptoms are not always present nor pathognomonic of this condition, and patients may be suffering for many years before a diagnosis is made. Incarceration and strangulation are rare, but they are life-threatening complications, warranting an emergent surgical repair. Hiatal hernia incarceration causing distal oesophagus perforation is even rarer. To our knowledge, this is the first case report in adult patients. Despite many advances in care, a high grade of suspicion is needed to diagnose this condition, and the mortality rate for an oesophageal perforation remains high, achieving 50% in some series. We present the surgical management of a case of hiatal hernia incarceration with distal oesophagus perforation by combined laparoscopy and upper endoscopy.
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Affiliation(s)
| | - Jorge Silva
- Gastroenterology Department, Centro Hospitalar Tamega e Sousa EPE, Guilhufe, Portugal
| | - Carla Freitas
- General Surgery, Esophagogastric Surgery Unit, Centro Hospitalar Tamega e Sousa EPE, Guilhufe, Portugal
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Geraedts ACM, Broos PPHL, Gronenschild MHM, Custers FLJ, Hulsewe KWE, Vissers YLJ, Loos ERD. Minimally Invasive Approach to Esophageal Perforation after Endoscopic Ultrasound-Guided Fine-Needle Aspiration: A Report of 2 Cases. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:313-316. [PMID: 32919448 PMCID: PMC7553825 DOI: 10.5090/kjtcs.19.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/16/2020] [Accepted: 02/22/2020] [Indexed: 11/16/2022]
Abstract
Esophageal perforation after endoscopic ultrasound-guided fine-needle aspiration for mediastinal staging is a rare but severe complication. We report 2 cases of patients with esophageal perforation who were treated using video-assisted thoracoscopic surgery in combination with esophageal stenting. Through these cases, the feasibility of minimally invasive thoracic surgery was evaluated.
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Affiliation(s)
- Anna C M Geraedts
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter P H L Broos
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | | | - Frank L J Custers
- Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Karel W E Hulsewe
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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Abila AW, Nditika ME, Kipkemoi RD, Ondigo S, Khwa-Otsyula BO. Primary repair of esophageal perforation: Case report. Int J Surg Case Rep 2020; 71:159-162. [PMID: 32454452 PMCID: PMC7248577 DOI: 10.1016/j.ijscr.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/28/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Mortality after esophageal perforation is high irrespective of the treatment modality. The rarity of traumatic esophageal perforations has made it difficult to conduct comprehensive studies that can answer pertinent questions with regard to management. PRESENTATION OF CASE We report a case of through and through thoracic esophageal injury caused by an assailant's arrow in a young physically active male adult. Diagnosis was made on-table. He successfully underwent primary repair of the esophageal injury 16 h post injury via a left thoracotomy. Recurrent lung collapse and pleural effusion was managed with tube thoracostomy and chest physiotherapy. DISCUSSION Esophageal perforations occur infrequently and may produce vague symptoms leading to diagnostic and therapeutic delays. High index of suspicion particularly in penetrating chest trauma followed by relevant investigations may reduce delay. Principles of management include treatment of contamination, wide local drainage, source control and nutritional support. Source control is achieved surgically or through endoluminal placement of stents. Surgical options include primary repair, creation of a controlled fistula by T-tube or esophageal exclusion. CONCLUSION Primary repair of traumatic injury to a healthy esophagus is feasible for cases diagnosed early and without significant mediastinal contamination as in our case. Associated injuries are more likely in such cases to lead to increased morbidity and prolonged hospital stay and must be handled carefully.
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Affiliation(s)
- Akello W Abila
- Department of Surgery and Anesthesiology, Moi University, School of Medicine, Eldoret, Kenya; Faculty of Health Sciences, Egerton University, Nakuru, Kenya.
| | - Mburu E Nditika
- Department of Surgery and Anesthesiology, Moi University, School of Medicine, Eldoret, Kenya
| | - Rono D Kipkemoi
- Faculty of Health Sciences, Egerton University, Nakuru, Kenya
| | - Stephen Ondigo
- Department of Cardiothoracic Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Barasa O Khwa-Otsyula
- Department of Surgery and Anesthesiology, Moi University, School of Medicine, Eldoret, Kenya; Department of Cardiothoracic Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya
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Abstract
GOALS To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. BACKGROUND Esophageal perforation is a serious complication of EoE. MATERIALS AND METHODS We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation. RESULTS Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair. CONCLUSIONS Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.
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An Unusual Case of Spontaneous Esophageal Rupture after Swallowing a Boneless Chicken Nugget. Case Rep Emerg Med 2016; 2016:5971656. [PMID: 26949552 PMCID: PMC4754474 DOI: 10.1155/2016/5971656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/10/2016] [Indexed: 01/07/2023] Open
Abstract
A 25-year-old previously healthy man presented to our Emergency Department with shortness of breath and epigastric pain after swallowing a boneless chicken nugget one hour prior to presentation. Physical examination revealed epigastric rigidity and tenderness. Serology was normal except for mildly elevated bilirubin and amylase. Computed tomography (CT) scan of the chest revealed a distal esophageal rupture with accompanying pneumomediastinum and left-sided pleural effusion. Treatment was initiated with administration of intravenous fluids and broad-spectrum antibiotics. Subsequently, an esophageal stent was inserted endoscopically in addition to VATS (Video-Assisted Thoracoscopic Surgery) drainage of the left-sided pleural space. This case illustrates an unusual presentation of Boerhaave's syndrome: a rare and life-threatening form of noniatrogenic esophageal rupture most often preceded by forceful vomiting. Our case demonstrates that physicians should maintain an index of suspicion for spontaneous esophageal rupture in patients presenting with shortness of breath and epigastric pain even in the absence of preceding vomiting, cough, or seizure. Additionally, ingestion of boneless, shell-less foods may be sufficient to cause rupture in individuals without underlying esophageal pathology. CT scan of the thorax and upper abdomen should be performed in these patients to rule out this rare and life-threatening diagnosis.
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