Treatment

The treatment of Boerhaave's syndrome is usually surgical. Ideally, this should be instituted within six hours of diagnosis and with stabilization of the patient: after this time, the metabolic effects and damage to the oesophagus make survival less likely.

Surgery entails draining the pleural cavity, searching for concomitant pathology at thoracotomy, e.g. tumours, oversewing the lesion, and closing the chest with an underwater seal drain. Oesophagectomy may be required for extensive stenosing lesions. Parenteral feeding or a feeding gastrostomy may be required.

Surgery has a 36% mortality, whereas medical management has a 65% mortality within 24 hours and a 100% mortality after one week.

But note, Larrieu et al. report of one case which was treated sucessfully with medical therapy (1).

Also Turut et a report the successful conservative treatment of a patient diagnosed 86 hours after presenting with chest pain (2).

• the authors suggest the main criterion of prognosis is not only the free interval between diagnosis and treatment but the clinical form. they suggest conservative management, including intrathoracic lavage and close monitorng in patients with late presentation with a distal esophageal tear

Reference:

• Larrieu AJ, Kieffer RBoerhaave syndrome: report of a case treated non-operatively. Ann Surg. 1975 Apr;181(4):452-4.
• Turut H, Gulhan E, Adams P Y, Cetin G. Successful conservative management of Boerhaave's syndrome with late presentation. J Natl Med Assoc. 2006;98(11):1857-1859