Boerhaave Syndrome in an Elderly Man

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Geriatric Medicine

Background:

• Boerhaave syndrome is a rare but serious condition characterized by esophageal rupture, often presenting non-specifically after forceful vomiting.
• Septic shock is a common complication due to extensive mediastinal and pleural infections.
• Management strategies include conservative, endoscopic, and surgical interventions.

Purpose of the Study:

• To present a case of Boerhaave syndrome in a 94-year-old patient.
• To discuss the suitability of an endoscopic approach in elderly patients with esophageal perforation.
• To emphasize the importance of a case-by-case management strategy in geriatric patients.

Main Methods:

• A 94-year-old male with community-acquired pneumonia developed esophageal perforation after vomiting.
• An endoscopic approach with esophageal prosthesis placement was utilized due to the patient's advanced age.
• Management included broad-spectrum antibiotics and prosthesis substitution for infected pleural effusion.

Main Results:

• The patient successfully underwent endoscopic management for esophageal perforation.
• Complications included infected pleural effusion requiring antibiotics and prosthesis replacement.
• The patient was discharged after 60 days with good functional status (80% Karnofsky score) and no oxygen requirement.

Conclusions:

• Boerhaave syndrome requires a tailored management approach, especially in the elderly population.
• Endoscopic treatment can be a viable option for esophageal rupture in non-surgical candidates.
• Balancing aggressive treatment with quality of life is crucial to prevent futile medical interventions in aging patients.