Nonoperative Management of Boerhaave Syndrome: A Case Study

Spontaneous esophageal rupture, also known as Boerhaave syndrome, represents an unusual yet clinically significant condition characterized by the rupture of the esophageal wall due to a sudden increase in intraluminal pressure, typically induced by vomiting, concomitant with negative intrathoracic pressure dynamics. This condition poses a challenging clinical entity, presenting high mortality rates, especially when treatment is delayed. Surgical intervention is frequently employed as the primary management strategy, while non-surgical approaches, including stent placement and endoluminal vacuum therapy, are less commonly utilized. This study aims to provide insights into the efficacy of non-operative management strategies by examining a clinical case. A 20-year-old male patient presented with fever, epigastric pain, excessive vomiting, and diarrhea over the past four days. A week prior, he had been examined at a private clinic, diagnosed with acute appendicitis, and managed conservatively with oral antibiotics. On the current admission, a contrast-enhanced thoracoabdominal CT scan revealed pneumomediastinum without fluid collection and portal vein thrombosis evidently due to acute appendicitis. Given the patient's favorable clinical status and the absence of collections in the mediastinum, a nonoperative approach was decided upon and was eventually successful. This case study concerns the sensible application of conservative modalities in selected patients with esophageal rupture.