Boerhaave syndrome natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2], Ajay Gade MD [3]], Feham Tariq, MD [4]

Overview

Boerhaave syndrome (BHS), if left untreated, mortality will reach 100%. Survival of Boerhaave’s syndrome is witin days. Most common complications of Boerhaave syndrome include pneumomediastinum, mediastinitis, sepsis, posterior mediastinal abscess. Boerhaave’s syndrome has a high mortality rate (14-40%).

The natural history of BHS is as follows:^[1]^[2]
Diagnosis of Boerhaave’s syndrome can easily be missed or delayed, leading to complications like dehydration, mediastinitis, sepsis and shock.
This accounts for the high mortality rate. If appropriate treatment is not started on time and if left untreated, the mortality rate reaches 100%.
Without adequate treatment, survival of Boerhaave’s syndrome is within days.

Most common complications of Boerhaave syndrome include:^[3]^[4]

Boerhaave’s syndrome has a high mortality rate (14-40%).The non-specific clinical signs contribute to the poor outcome of Boerhaave syndrome. ^[5]^[6]

↑ Tamatey MN, Sereboe LA, Tettey MM, Entsua-Mensah K, Gyan B (2013). “Boerhaave’s syndrome: diagnosis and successful primary repair one month after the oesophageal perforation”. Ghana Med J. 47 (1): 53–5. PMC 3645189. PMID 23661858.
↑ Boerhaave syndrome at eMedicine
↑ Ahmad R, Ishlah W, Shaharudin MH, Sathananthar KS, Norie A (2008). “Posterior mediastinal abscess secondary to esophageal perforation following fish bone ingestion”. Med. J. Malaysia. 63 (2): 162–3. PMID 18942310.
↑ Maurya VK, Sharma P, Ravikumar R, Bhatia M (2016). “Boerhaave’s syndrome”. Med J Armed Forces India. 72 (Suppl 1): S105–S107. doi:10.1016/j.mjafi.2015.12.004. PMC 5192176. PMID 28050085.
↑ Haveman JW, Nieuwenhuijs VB, Kobold JP, van Dam GM, Plukker JT, Hofker HS (2011). “Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave’s syndrome”. Surg Endosc. 25 (8): 2492–7. doi:10.1007/s00464-011-1571-y. PMC 3142333. PMID 21359901.
↑ Lu H, Carron PN, Godat S, Pittet R (2018). “[Boerhaave syndrome: update on physiopathology, diagnosis and early management]”. Rev Med Suisse (in French). 14 (592): 299–303. PMID 29384279.