Boerhaave's syndrome: long free interval before successful primary repair. Case report

Report case of a 66-year-old man come to our observation for a bilateral pleural effusion, ten days after clinical manifestations of chest pain, initially misdiagnosed with a myocardial infarction.

On the same day, the patient underwent an emergency chest CT scan with orally administered contrast medium that confirmed our suspicion of breakage of the esophageal wall. The patient underwent to a left thoracotomy: the visceral pleura and all the structures covered by the parietal pleura were affected by a widespread necrotic process. The subsequent cleansing of the pleural cavity revealed that the distal portion of the thoracic esophagus was lacerated for about 5 cm; the tear was repaired with continuous reabsorbable sutures; to protect the suture fundoplication of the gastric fundus was performed.

Post-operative course was complicated on 15th day by a chylous spreading from the chest drains; to complete the postoperative checks, a chest CT scan was therefore performed, orally administering the contrast medium without any signs of extraluminal spreading; the chylous effusion resolved spontaneously with diet. After being discharged, the patient was followed on an outpatient basis for 36 months.

Boerhaave's syndrome is a rare and serious clinical condition; when a patient is diagnosed after 24-48 hs, many surgeons follow conservative treatment; however primary repair can be safely accomplished regardless of the time interval between perforation and operation, like our singular experience demonstrated