Treatment of spontaneous esophageal rupture: 11 years of experience

Incoordination of emesis may induce injury of the gastric cardiac portion, gastroesophageal junction, and distal portion of the esophagus. In a review of six males with Boerhaave's syndrome, one ruptured site of the esophagus was on the right, and five were on the left side. They all received direct repair with or without the pericardial fat pad buttressing technique and drainage procedure. One patient who had uremia and septic shock died in the process of exploratory thoracotomy. The location of the rent was 2.3 (1.0-3.5) cm above the diaphragm, with a mean of 3.4 (1.5-8.0) cm in length. The mean interval between perforation and operation was 25.4 hours (three-cases > 24 hours). One of these three cases with late diagnosis had postoperative esophago-pleural fistula and was successfully treated with TPN, antibiotics, chest tube drainage, and transesophageal irrigation. The postoperative gastro-esophageal reflux could be detected by Tc-99m DTPA (Technetium-diethylene triamine penta acetic acid) gastro-esophageal reflux study in one patient only (1/4, 25%). We conclude that timely primary surgical repair with pleural and mediastinal drainage is the best treatment. Conservative treatment can be reserved for cases with failed primary repair but without severe toxin sign. The incidence of gastro-esophageal reflux was low in our series on the basis of Tc-99m DTPA gastroesophageal reflux test.