Breaking barriers in Boerhaave syndrome: a case of successful non-surgical treatment

Shivadev M.; Brajesh B. Gupta; Unmed Chandak; Prasad Bansod; Shweta Gupta; Neel Mehta; Shikha Tolani; Subodh Behera; Sanskruti Akulwar; Gaurav Nighot; Ashlesha Ganorkar; Nishant Sawadetkar

doi:10.18203/2349-2902.isj20250580

Authors

Shivadev M. Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Brajesh B. Gupta Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Unmed Chandak Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Prasad Bansod Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Shweta Gupta Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Neel Mehta Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Shikha Tolani Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Subodh Behera Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Sanskruti Akulwar Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Gaurav Nighot Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Ashlesha Ganorkar Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India
Nishant Sawadetkar Department of General Surgery, Government Medical College Nagpur, Nagpur Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20250580

Keywords:

Boerhaave syndrome, Esophageal perforation, Mediastinitis, Endoluminal vacuum therapy, Esophageopleural fistula

Abstract

Boerhaave syndrome is a rare and life-threatening condition characterized by spontaneous esophageal rupture, commonly resulting from severe vomiting. It carries a high mortality rate if untreated, particularly in delayed presentations. This report details a 44-year-old male with symptoms of breathlessness, chest pain, and vomiting after binge drinking. Initial management included nasogastric and intercostal drainage, antibiotics, and total parenteral nutrition. Diagnostic imaging revealed a left-sided esophageal tear with a fistula to the pleural cavity. Conservative treatment combined endoluminal vacuum therapy with other supportive measures, successfully reducing the esophageal defect and associated complications. The patient recovered without requiring additional surgical intervention, highlighting the potential of conservative approaches in carefully selected cases of Boerhaave syndrome. This case underscores the importance of timely diagnosis, multidisciplinary management, and advanced endoscopic therapies in achieving positive outcomes for a condition traditionally managed surgically.

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