A rare incidence of recurrent Boerhaave’s syndrome: an alternative operative approach—case report

Abstract

Boerhaave’s syndrome is a rare condition. It is associated with a high morbidity and mortality. We describe a very rare incidence of oesophageal perforation that occurred again in the same patient, four years following the first incidence with no clear causative factor apart from Barrett’s oesophagus. Our patient presented with multiple vomits and nausea followed by acute epigastric and right upper quadrant pain. Boerhaave’s syndrome is a condition with a high morbidity and mortality rate. In very rare cases, it has been reported to occur twice in the same patient as was seen in our case. The first oesophageal perforation was repaired via a right thoracic approach while the second perforation was successfully repaired via a classical abdominal approach. To our knowledge this is the first in the literature to describe this approach for this condition. A summative a literature review was performed which identified eleven reported cases and found a lack of specific risk factors apart from moderate to heavy alcohol intake, and a non-specific set of symptoms for re-presentations. Thus, we suggest having a lower clinical threshold for imaging patients with a history of primary Boerhaave’s syndrome who present with equivocal symptoms of a recurrent episode given that time to surgery within 24 hours is a known factor for significantly improved outcomes.