Diagnosis and Treatment of 34 Patients with Spontaneous Esophageal Rupture_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Weiguo , SU Yusheng , SHI Weiping , SHI Hongcan , LU Shichun.

Department of Cardiothoracic Surgery， Subei People’s Hospital， Yangzhou 225001， Jiangsu， P. R. China;

Corresponding author：

Keywords：

Spontaneous esophageal rupture; ?Diagnosis; ?Treatment; ?Boerhaave’s syndrome

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Objective?To investigate clinical characteristics， diagnosis， and treatment for patients with spontaneous　esophageal rupture， and improve clinical diagnostic and treatment level.?Methods?We retrospectively analyzed the　clinical data of 34 patients with spontaneous esophageal rupture who were treated in Subei People’s Hospital from January 1996 to June 2010. There were 28 male patients and 6 female patients with their age ranging from 32 to 80 years old (mean 57.6 years old). Main clinical manifestations included severe chest and abdominal pain after vomiting， fever， dyspnea and shock. The duration between disease onset and establishing diagnosis ranged from 4 hours to 7 days. Thirteen patients received conservative treatment including chest drainage， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy. Twenty one patients received surgical treatment including layered anastomosis of the ruptured esophagus， retrograde gastrointestinal decompression and enteral nutrition through jejunostomy.?Results?All the patients were cured without in-hospital death. The mean hospital stay of the 13 patients who received conservative treatment was 46 days， while that of the 21 patients who received surgical treatment was 17 days. All the ruptured esophagus were one-stage healed. All the 34 patients were followed up from l to 8 years， including 11 patients in the conservative treatment group and 19 patients in the surgical treatment group， but 4 patients was lost during follow-up. All the patients had a normal diet without symptoms of esophageal stricture， reflux esophagitis or chronic thoracic empyema.?Conclusion　Spontaneous esophageal rupture is a thoracic emergency with a high misdiagnosis rate and mortality．Early diagnosis， early surgical repair of ruptured esophagus and satisfactory chest drainage play a vital role in the treatment for patients with spontaneous rupture of esophagus.

Citation： JIN Weiguo,SU Yusheng,SHI Weiping,SHI Hongcan,LU Shichun.. Diagnosis and Treatment of 34 Patients with Spontaneous Esophageal Rupture. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 476-478. doi: Copy

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1. 　顾恺时，主编. 顾恺时胸心外科手术学. 上海：上海科学技术出版社， 2003. 977-983.
2. 　王惠宾. 自发性食管破裂治疗5例分析. 中国误诊学杂志， 2012， 12 （4）：942.
3. 　王建立，齐宗华. 自发性食管破裂16例治疗体会. 郑州大学学报：医学版， 2009， 44 （3）：689-690.
4. 　高学新，张玉坤. 自发性食管破裂处理体会. 泰山医学院学报， 2006， 27 （7）：658-659.
5. 　高丽萍，马洪升. 自发性食管破裂的诊断及治疗进展. 国际消化病杂志， 2010， 30 （6）：338-339.
6. 　刘玉忠. 自发性食管破裂19例临床分析. 当代医学， 2009， 15 （7）：64-65.
7. 　崔永，王天佑，王化生. 自发性食管破裂的诊断与治疗. 中华外科杂志， 2005， 43 （6）：404-405.
8. 　Haveman JW， Nieuwenhuijs VB， Kobold JP， et al. Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome. Surg Endosc， 2011， 25 （8）：2492-2497.
9. 　张毅，魏翔，潘铁成. 自发性食管破裂的早期诊断和外科治疗. 临床肺科杂志， 2010， 15 （5）：669-670.
10. 　Ando H， Shitara Y， Hagiwara K， et al. Successful surgical treatment of a spontaneous rupture of the esophagus diagnosed two days after onset. Case Rep Gastroenterol， 2012， 6 （2）：260-265.
11. 　Mahmodlou R， Abdirad I， Ghasemi-Rad M. Aggressive surgical treatment in late-diagnosed esophageal perforation：a report of 11 cases. ISRN surgery ， 2011：868356.
12. 　束余声，肖文恩，石维平，等. 联合应用空肠双管造瘘及胸腔灌洗保守治疗食管自发性破裂. 实用医学杂志， 2000， 16 （6）：455-456.
13. 　van Boeckel PG， Dua KS， Weusten BL， et al. SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks. BMC Gastroenterol， 2012，12：19.
14. 　Fiscon V， Portale G， Frigo F， et al. Spontaneous rupture of middle thoracic esophagus：thoracoscopic treatment. Surg Endosc， 2010， 24 （11）：2900-2902.
15. 　Vaidya S， Prabhudessai S， Jhawar N， et al. Boerhaave’s syndrome：Thoracolaparoscopic approach. J Minim Access Surg， 2010， 6 （3）：76-79.
16. 　刘胜中，曾富春，冯刚，等. 自发性食管破裂17例诊治体会. 四川医学， 2011， 32 （8）：1195-1197.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Treatment of 34 Patients with Spontaneous Esophageal Rupture

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