A case of Boerhaave Syndrome treated at BGS Gleneagles Global Hospitals

Boerhaave Syndrome refers to esophageal perforations which occur due to vomiting. The condition is associated with high morbidity and mortality and is fatal without treatment

Boerhaave’s Syndrome is a lethal disease of the gastrointestinal tract, with a high mortality rate. It occurs when there is a spontaneous perforation of the esophageal tract. It is a rare medical condition, with an incidence rate of 3.1 cases per 1000000 a year. A few months ago, one such severe case was diagnosed at BGS Gleneagles Global Hospitals in Kengeri. Uday (name changed), a 56 year old gentleman presented with retching and vomiting. He was also suffering from severe chest and abdominal pain along with difficulty in breathing. He was referred to the hospital after suspicion of a heart related ailment.

Doctors at BGS Gleneagles Global Hospitals ran a few tests including a chest X ray and CT scan of the thorax and abdomen which helped identify a tear in the lower food pipe; a condition called Boerhaave Syndrome. He was urgently seen by a surgical group and he underwent surgery to drain the accumulated pus and treat the tear in the esophagus.

Without treatment, survival of Boerhaave’s syndrome is in days. In this case, if the condition was not detected at the right time and if surgery was not done immediately, the patient may have died in a short while. Therefore, management relies on rapid recognition and intervention, as lack of therapeutic interventions can be fatal.

Unfortunately, just as Uday was believed to be recovering, he developed a fever. An investigation revealed a hole in the lower esophagus. Doctors were left with fewer options as the patient had just undergone surgery two weeks earlier. A repeat surgery would be risky. The doctors opted for a newer endoscopic modality which involved ‘over the scope clipping’. In a 45 minute long procedure, Dr Adarsh CK, Consultant Gastroenterologist and Hepatologist and his team, corrected the leakage in the food pipe. In this method, a metal stent was placed on the tear in the food pipe thereby helping it heal better. As a result, the patient was able to take oral feed within a few days.

Uday’s condition improved gradually and he slowly gained weight. The metal stent was removed endoscopically three months later.
Dr Adarsh CK, Consultant Gastroenterologist and Hepatologist at BGS Gleneagles Global Hospitals, Bengaluru said, “Perforation of the esophagus as seen in Boerhaave Syndrome constitutes a true emergency that demands immediate diagnosis and superior surgical judgement. Appropriate surgical intervention is the approach that has significantly improved the outcome of this fatal condition. Newer endoscopic methods have further revolutionised treatment allowing us to avoid surgery. Endoscopic method also reduces cost, duration of hospital stay and suffering of the patient.”
It has been 6 months since Uday’s stent was removed. He has gained 10 kilos and is on a normal diet. His experience is important to build awareness on this condition and available treatment modalities. It is interesting to note that very few cases have been managed endoscopically and therefore scarcely reported in medical literature.

Boerhaave syndrome is a rather uncommon medical condition. This tends to occur when a person forcefully retches/vomits or coughs vigorously. Over indulgence in food or alcohol are major risk factors for spontaneous perforation of the esophagus. History of increased intra-esophageal pressure for any reason followed by chest pain or breathing difficulty should prompt consideration of this condition.

“Our division of Gastroenterology and Hepatology at BGS Gleneagles Global Hospitals is one of the largest and most deeply experienced in the state. The digestive diseases experts on our team specialise in preventing, diagnosing and treating digestive tract and liver disorders. This rare case further highlights their expertise. Our doctors are trained in using the latest in endoscopic equipment and minimally invasive techniques. “added Shailaja Suresh, CEO, Gleneagles Global Hospitals Bengaluru.