Alternative management of delayed spontaneous oesophageal perforation by endoscopic stenting
- Resource Type
- Authors
- Adan Castrodad; Christina Zhu; Ariel P. Santos
- Source
- BMJ case reports. 14(7)
- Subject
- Adult
Male
medicine.medical_specialty
Pleural effusion
medicine.medical_treatment
Spontaneous Perforation
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Percutaneous endoscopic gastrostomy
medicine
Mediastinal Diseases
Humans
Endoscopic stenting
Thoracotomy
Esophageal Perforation
medicine.diagnostic_test
Rupture, Spontaneous
business.industry
Stent
Endoscopy
General Medicine
medicine.disease
Empyema
Surgery
030211 gastroenterology & hepatology
Stents
business
- Language
- ISSN
- 1757-790X
Boerhaave’s syndrome or spontaneous perforation of the oesophagus is a life-threatening condition that carries high mortality. Delayed diagnosis has a mortality rate of 20%–50%. While surgical intervention has been the mainstay of treatment, advancements in endoscopy and oesophageal stenting have allowed for alternative management. Our case involves a 33-year-old man with self-induced emesis and DKA. After 10 days in the ICU, he developed a large right pleural effusion, which was treated with chest tube placement. Upper GI study confirmed delayed Boerhaave’s syndrome. A self-expanding stent was inserted followed by percutaneous endoscopic gastrostomy (PEG) for decompression and jejunal extension for nutrition. He developed empyema and underwent right thoracotomy for washout and lung decortication. Stent was exchanged once due to recurrent leak following migration and removed after 40 days. Endoscopic stent placement with PEG with jejunal extension followed by thoracotomy is a viable alternative to primary repair of delayed oesophageal perforation.