Endoscopic management of failed surgical repair of Boerhaave's syndrome

8^th INTERNATIONAL CONFERENCE ON GLOBAL HEALTHCARE

May 10, 2022 | Webinar

Shankar Zanwar

Shri M P Shah medical college, India

Posters & Accepted Abstracts: Health Pol

Abstract :

Boerhaave’s syndrome is acute spontaneous perforation of the lower esophagus have severe retching. Rupture of the intrathoracic esophagus results in contamination of the mediastinal cavity with gastric contents. This leads to chemical mediastinitis with mediastinal emphysema and inflammation, and subsequently bacterial infection and mediastinal necrosis. The incidence of Boerhaave syndrome is relatively rare, with an estimated incidence of 3.1 per 1,000,000 persons per year1. Management depends on site, duration and extent of the rupture. This condition can be managed medically, surgically and endoscopically. We present our case which was initially attempted to managed medically and surgically which failed and was later referred to us. We used padlock clip endoscopically, placed a metal stent to reinforce the clip function and also did a venting PEG (percutaneous endoscopic gastrostomy)2 to prevent retrograde leaking. To best of our knowledge this the first case of use of padlock clips for management of Boerhaave’s syndrome. We would like to emphasis the need for early consideration of endoscopic management in esophageal rupture and use of over-the-scope clips can be beneficial. We would also reiterate here the importance of use of a venting PEG to avoid a retrograde leak. A team effort with surgeons and intensivist in management of this disease is paramount.
Recent Publications :
1. Nayak SK, Preethi M, Zanwar S, Palaniswamy KR. Cannabis induced recurrent acute pancreatitis. Tropical Doctor. 2016;46(4):238-239. doi:10.1177/0049475515613238
2. Zanwar S, Mohan AT, Paramsivan P, Parmeswaran SA, Srinivas U, Mutthuswamy H, Dhus U, Venkatesh S, Mahalingam P, Ramasamy PK, Nayak S, Parikh P. A novel “BISSHOAP” score for predicting severe and moderately severe acute pancreatitis in emergency room. Gastroenterol Hepatol Endosc Pract 2021; 1:111-5
3. Zanwar S, Chawhare S, Thorat A. Salvaging migrated lumen apposing metal stent during necrosectomy for walled off pancreatic necrosis in disconnected pancreatic duct syndrome. Gastroenterol Hepatol Endosc Pract [cited 2021 Dec 17]; 1:148-50.