Boerhaave syndrome: a diagnostic conundrum.

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Spontaneous esophageal rupture (Boerhaave syndrome) is a rare but life-threatening condition.
• Post-operative complications following elective surgery can be diverse and severe.
• Early recognition and management are crucial for patient survival.

Purpose of the Study:

• To report a unique case of Boerhaave syndrome presenting after total knee replacement.
• To highlight the diagnostic challenges and successful conservative management of this rare complication.
• To emphasize the importance of considering esophageal rupture in post-operative patients with abdominal pain and respiratory distress.

Main Methods:

• Case report of a 79-year-old male patient.
• Clinical presentation, diagnostic workup including imaging and pleural fluid analysis (pH, amylase).
• Management strategies including pleural space drainage and conservative treatment of esophageal leak.

Main Results:

• The patient developed rapid onset of abdominal pain, fever, hypotension, and respiratory failure post-knee replacement.
• Pleural fluid analysis revealed a high amylase level, indicative of esophageal rupture.
• Despite initial shock and multiorgan failure, conservative management with intercostal tube drainage led to a full recovery.

Conclusions:

• Boerhaave syndrome can occur atypically after non-esophageal surgery, such as total knee replacement.
• High pleural fluid amylase is a key diagnostic marker for esophageal rupture.
• Conservative management, including pleural drainage, can be successful in selected cases of spontaneous esophageal rupture, leading to favorable outcomes.