CONTEMPORARY APPROACHES TO BOERHAAVE SYNDROME: CHALLENGES AND ADVANCES IN DIAGNOSIS AND TREATMENT

Анотація

Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a rare but potentially fatal condition characterized by a full-thickness tear of the esophageal wall. It is most commonly caused by a sudden increase in intraesophageal pressure, often following severe vomiting, which is typically triggered by overeating, alcohol consumption, or other factors inducing violent retching. First described by the Dutch physician Hermann Boerhaave in 1724, this syndrome remains one of the most lethal conditions in gastroenterology, with historically high mortality rates when diagnosis and treatment are delayed. The classic clinical presentation includes vomiting, chest pain, and subcutaneous emphysema, collectively known as Mackler's triad. However, these symptoms are not universally present and occur in only about 14% of cases, which often leads to delayed diagnosis and treatment. Due to its similarity to other acute conditions like myocardial infarction, pneumothorax, and Mallory-Weiss syndrome, accurate and timely differential diagnosis is crucial.

While surgical intervention has traditionally been the standard treatment for Boerhaave syndrome, recent research suggests that conservative management may be effective in selected patients, particularly those diagnosed early and in stable conditions. Advances in diagnostic imaging, particularly contrast-enhanced computed tomography, have significantly improved the ability to diagnose this condition with high sensitivity. CT scans provide detailed visualization of mediastinal fluid collections, pneumomediastinum, pleural effusions, and other signs indicative of esophageal rupture. Conservative management typically includes broad-spectrum antibiotics, intravenous fluids, drainage of mediastinal collections, and careful monitoring for complications. Endoscopic techniques, such as stent placement or use of the Over-the-Scope Clip (OTSC®), have also shown promise in treating selected cases without the need for surgery. Despite the challenges, a growing body of evidence demonstrates that with appropriate clinical monitoring and timely intervention, even patients with severe presentations can achieve full recovery without requiring open surgery. This review synthesizes the latest research, highlights the evolving role of conservative management, and provides insights into the future of treatment for Boerhaave syndrome.

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