Treatment of Boerhaave syndrome: experience from a tertiary center

Abstract

Background: Boerhaave syndrome is a rare, life-threatening condition, characterized by spontaneous esophageal rupture. This study aims to share our 13-year experience in managing Boerhaave syndrome. Methods: A retrospective, observational study was conducted of consecutive patients with Boerhaave syndrome who presented at our tertiary referral center, between 2011 and 2023. Patients were categorized by time to diagnosis, to assess the impact of diagnostic delay. Results: Among 21 patients, 13 (62%) were diagnosed early (< 24 h) and 8 (38%) late (> 24 h). In the early-diagnosed group (n = 13), 6 patients (46%) received primary intervention with stent placement in combination with surgical drainage (5 with mediastinal and pleural drainage and 1 with only pleural drainage), while 5 patients (38%) were initially treated with only a stent. One patient (8%) underwent surgical pleural drainage alone and one (8%) underwent an esophagectomy. Among the 8 late-diagnosed patients, 4 (50%) were primarily treated with both stent placement and surgical drainage (2 with mediastinal drainage, 1 with pleural drainage and 1 with both), 3 (38%) with only stent placement, and one (13%) was managed conservatively. Additional interventions were required in 14 patients (67%). Additional surgical drainage was performed in 5 of 8 patients who had initially been treated with stent only (63%) and in 2 of 10 patients who had initially received both stent and surgical drainage (20%). Stent complications occurred in 7 patients (37%), including leakage (16%), migration (16%), and bleeding (5%). The median hospital stay was 32 days (IQR 15–37) and the overall 90-day mortality was 14%. Mortality was significantly higher in late-diagnosed patients (n = 3, 38%) compared to those early diagnosed (n = 0, 0%) (p = 0.042), with all 3 deceased patients either refusing or being unfit for treatment. Conclusion: Based on this study, we recommend prioritizing closure of the defect combined with drainage, while considering individual patient factors, including advanced age.