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• W4387249369 abstract "SESSION TITLE: Cardiothoracic Surgery Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Boerhaave syndrome also known as, esophageal rupture is a relatively rare pathology. It occurs approximately 3.1 per 1000,000 per year. It accounts for 15% of cases of esophageal perforations (1). Diagnosis may be missed, because symptoms can be vague, and differentials are broad (2). We present a case in which the patient presented with the Mackler triad, consisting of vomiting, chest pain and severe subcutaneous emphysema. CASE PRESENTATION: An 80-year-old male with past medical history of hemorrhagic stroke in 2016 from brain aneurysm, hypertension, hyperlipidemia, benign prostatic hyperplasia and chronic urinary retention presented to emergency department with acute onset chest pain. He was in his usual state of health until 1 day ago. His dinner consisted of chicken sandwich and small amount of whiskey. At 8 am, he woke up nauseous and vomited 3 times in restroom. Vomitus contained food that he ate the night before, no coffee ground emesis or hematemesis was noted. Upon emerging from restroom, roughly 20 min later, he was diaphoretic, reporting chest pain that was pleuritic in nature. He was brought to emergency department, where he continued to endorse pain and shortness of breath. Vitals on arrival were stable but within few hours, his heart rate increased up to 123, and respiratory rate up to 30-40 for which nonrebreather was placed. His initial lab work revealed WBC 4.5 with bands 18 %, Hgb 18.4 g/dl, hematocrit 57%, and platelets 212/micro lit. Liver function test, albumin, and troponin were normal. Chest x-ray showed large left hydropneumothorax with severe subcutaneous emphysema. CT chest findings were consistent distal esophageal perforation, severe pneumomediastinum and large left hydropneumothorax. Sepsis bolus and antibiotics were given. Emergent left sided chest tube was placed with drainage of 1800ml fluid. CT chest with oral contrast showed extensive contrast extravasation from distal esophagus into left pleural cavity. Esophagogastroduodenoscopy (EGD) showed a leftward linear tear in esophagus extending 2 cm just above the gastroesophageal (GE) junction. Due to extend of tear and significant contamination of chest, left thoracotomy and repair of the esophageal tear was done. Dense adhesion between lung and chest wall were present that were debrided. Repeat endoscopy did not reveal any residual defect. Culture from pleural collection grew pan-sensitive candida albicans, streptococcus viridans, streptococcus angionosus. CT chest on day 7, showed fluid collection containing oral contrast located centrally in mediastinum measuring 7.9 x 2.6 cm. He underwent repeat right-sided thoracotomy for abscess drainage. The clinical course was complicated by leakage from repair site. Pt underwent repeat EGD and it showed some leakage from linear defect but no frank perforation. His oral feed was restricted at this point and a jejunostomy tube for feeding purposes was placed. He was then discharged to rehab in a stable condition. DISCUSSION: Boerhaave syndrome is a relatively rare pathology. Classic presentation in older age is rare, which played a key role in early diagnosis and timely surgical intervention that changed our patient outcomes and survival. CONCLUSIONS: Boerhaave syndrome is uncommon and early surgical intervention prevents mortality, despite high morbidity. REFERENCE #1: Turner AR, Turner SD. Boerhaave Syndrome.; 2022. REFERENCE #2: Li J. A Rare Case of Boerhaave Syndrome Presenting with Right Tension Pneumothorax and Review of the Literature. International Journal of Critical Care and Emergency Medicine. 2017;3(1). doi:10.23937/2474-3674/1510025 DISCLOSURES: No relevant relationships by Nayaab Bakshi No relevant relationships by Sharath Bellary No relevant relationships by Nyan Bethel No relevant relationships by Mit Chauhan No relevant relationships by Asma Jamil No relevant relationships by Talha Munir" @default.
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• W4387249369 date "2023-10-01" @default.
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• W4387249369 title "BOERHAAVE SYNDROME: RARE PRESENTATION WITH ATYPICAL OUTCOME" @default.
• W4387249369 doi "https://doi.org/10.1016/j.chest.2023.07.173" @default.
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