Boerhaave Syndrome in an Elderly Man
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndro...
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2018-09-01
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doaj-9d908094630a407e9f5ad15015d702892020-11-24T23:04:24ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942018-09-0110.12890/2018_000944944Boerhaave Syndrome in an Elderly ManMaria João Rodrigues Ferreira Pinto0Pedro Rodrigues1Leonor Almeida2Alexandra Leitão3Luís Flores4André Gomes5Gonçalo Rocha6Fernando Friões7Internal Medicine Department, Centro Hospitalar de São João, Porto, PortugalInternal Medicine Department, Centro Hospitalar de São João, Porto, PortugalPneumology Department, Centro Hospitalar de São João, Porto, PortugalInternal Medicine Department, Hospital Santa Maria Maior, Barcelos, PortugalInternal Medicine Department, Centro Hospitalar de São João, Porto, PortugalInternal Medicine Department, Centro Hospitalar de São João, Porto, PortugalInternal Medicine Department, Centro Hospitalar de São João, Porto, PortugalInternal Medicine Department, Centro Hospitalar de São João, Porto, PortugalBoerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment.https://www.ejcrim.com/index.php/EJCRIM/article/view/944Oesophageal perforationBoerhaave syndromepneumothoraxpleural effusion |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Maria João Rodrigues Ferreira Pinto Pedro Rodrigues Leonor Almeida Alexandra Leitão Luís Flores André Gomes Gonçalo Rocha Fernando Friões |
spellingShingle |
Maria João Rodrigues Ferreira Pinto Pedro Rodrigues Leonor Almeida Alexandra Leitão Luís Flores André Gomes Gonçalo Rocha Fernando Friões Boerhaave Syndrome in an Elderly Man European Journal of Case Reports in Internal Medicine Oesophageal perforation Boerhaave syndrome pneumothorax pleural effusion |
author_facet |
Maria João Rodrigues Ferreira Pinto Pedro Rodrigues Leonor Almeida Alexandra Leitão Luís Flores André Gomes Gonçalo Rocha Fernando Friões |
author_sort |
Maria João Rodrigues Ferreira Pinto |
title |
Boerhaave Syndrome in an Elderly Man |
title_short |
Boerhaave Syndrome in an Elderly Man |
title_full |
Boerhaave Syndrome in an Elderly Man |
title_fullStr |
Boerhaave Syndrome in an Elderly Man |
title_full_unstemmed |
Boerhaave Syndrome in an Elderly Man |
title_sort |
boerhaave syndrome in an elderly man |
publisher |
SMC MEDIA SRL |
series |
European Journal of Case Reports in Internal Medicine |
issn |
2284-2594 |
publishDate |
2018-09-01 |
description |
Boerhaave syndrome is rare, has an non-specific clinical presentation and most commonly develops after persistent vomiting. Septic shock dominates the clinical picture as a result of extensive infection of the mediastinum and pleural and abdominal cavities. The current management of Boerhaave syndrome includes conservative, endoscopic and surgical treatments. The authors present the case of a 94-year-old man admitted to hospital with community-acquired pneumonia with mild respiratory insufficiency complicated by oesophageal perforation after an episode of vomiting and the development of a large left pleural effusion. An endoscopic approach with the placement of an oesophageal prosthesis was chosen given the advanced age of the patient. The hospital stay was complicated by pleural effusion infection requiring broad-spectrum antibiotics and prosthesis substitution. The patient was discharged after 60 days of hospitalization, without the need for oxygen supplementation, and scoring 80% on the Karnofsky Performance Status Scale. The increase in average life expectancy requires a case-by-case approach, where the benefits of invasive manoeuvres and likelihood of discharge are weighed against an acceptable quality of life, aiming to prevent futile medical treatment. |
topic |
Oesophageal perforation Boerhaave syndrome pneumothorax pleural effusion |
url |
https://www.ejcrim.com/index.php/EJCRIM/article/view/944 |
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