AN INTERESTING CASE OF BOERHAAVE'S SYNDROME

Boerhavve's syndrome or spontaneous oesophageal perforation is a rare condition in day to day practice but has high mortality if not treated early. The various options for treating spontaneous oesophageal perforation include surgery and endotherapy.

A 80 year old male with multiple comorbidities (diabetic, hypertensive and coronary artery disease) presented with chest pain, breathlessness for one day. CT scan was done and it showed oesophageal perforation at the distal end with mediastinal collection and pleural effusion. Patient was started on iv fluids and antibiotics. A intercostal drain was inserted.

Endoscopy was done and it showed a tear at the 34cms of oesophagus. We thought of clipping the tear but opted against it because we felt that edges will not hold the clip.

We then decided to cover the tear with a covered metallic stent. We used a 15cms Fully covered metallic stent with body diameter of 22 mm and flange diameter of 30 mm.

2 clips were also applied at the top of the stent to prevent its migration.

Ryles tube was inserted thro the stent and placed into the stomach to facilitate feeding.

After 4 days a repeat CT scan was done and it showed no leak. Patient was put on antibiotics for 10 days and icd was removed after a week. Ryle's tube was removed on the 3 rd week and started on oral feeds. Patient improved gradually and Stent was removed after 5 weeks. Repeat endoscopy showed small ulcerations at the site. Esophagogram done with oral water soluble contrast does not reveal any obvious leak.

We conclude that Oesophageal stenting is an effective and minimally invasive option for patients with spontaneous oesophageal perforation.