Daily Ards Research Analysis
Analyzed 1 papers and selected 3 impactful papers.
Summary
Analyzed 1 papers and selected 3 impactful articles.
Selected Articles
1. Successful multistage surgical management of Boerhaave syndrome: a case report and review of the literature.
This case report details a 36-year-old man with Boerhaave syndrome complicated by right hydropneumothorax, mediastinitis, and sepsis. Initial organ-preserving endoscopic stenting failed due to migration causing mediastinitis, necessitating esophagectomy and feeding jejunostomy; definitive retrosternal gastric conduit reconstruction was performed after sepsis control and nutritional rehabilitation, with eventual discharge on oral feeding.
Impact: Illustrates a practical, staged surgical strategy for complex Boerhaave syndrome with sepsis, showing that delayed reconstruction after sepsis control and nutritional optimization can yield good outcomes—useful guidance for thoracic surgeons and intensivists facing similar cases.
Clinical Implications: For patients with Boerhaave syndrome complicated by hydropneumothorax and mediastinitis, early thoracic drainage and sepsis control are critical; organ-preserving stenting can be attempted but clinicians must monitor for stent migration and be prepared to escalate to esophagectomy with staged reconstruction once infection is controlled and nutrition improved.
Key Findings
- Initial organ-preserving strategy using endoscopic esophageal stent failed due to stent migration, resulting in mediastinitis and sepsis.
- Early thoracic drainage and control of sepsis were essential to stabilize the patient before definitive reconstruction.
- Delayed definitive reconstruction (retrosternal gastric conduit pull-up) after nutritional rehabilitation led to discharge on oral feeding and good long-term outcome in this case.
Methodological Strengths
- Detailed stepwise clinical timeline including imaging, endoscopic intervention, surgical procedures, and ICU course.
- Integration of surgical decision-making with infection control and nutritional management, providing practical procedural detail.
Limitations
- Single case report limits generalizability and does not allow comparison between management strategies.
- Exact durations of ICU and long-term unit stays and long-term functional outcomes beyond discharge are not quantified.
Future Directions: Larger case series or prospective cohorts should compare organ-preserving strategies (stenting) versus early definitive surgery, define optimal timing for reconstruction after sepsis control, and quantify functional outcomes and quality of life after staged management.
BACKGROUND: Boerhaave's syndrome is a rare cause of spontaneous transmural esophageal perforation and carries high morbidity and mortality, as its classical presentation (such as Mackler's triad of vomiting, chest pain, and subcutaneous emphysema) is infrequent and diagnosis is often delayed. Early diagnosis and urgent intervention are needed. CASE PRESENTATION: This case report presents a 36-year-old Asian male admitted to the emergency department with acute chest pain and respiratory distress after multiple episodes of vomiting. Thoracic computed tomography (CT) revealed distal esophageal perforation with right hydropneumothorax. The patient was managed surgically, initially with pleural drainage and endoscopic esophageal stenting as an organ-preserving strategy, but migration of the stent with mediastinitis and sepsis necessitated esophagectomy and feeding jejunostomy. Definitive management with retrosternal gastric conduit pull-up and esophageal reconstruction was performed once sepsis was controlled and nutritional status improved, and after a prolonged stay in the long-term care unit and intensive care unit (ICU), the patient was discharged in good clinical condition on oral feeding. CONCLUSIONS: Boerhaave's syndrome is a rare but potentially life-threatening cause of esophageal perforation, particularly when complicated by massive hydropneumothorax and mediastinitis. This case illustrates that aggressive, multidisciplinary, multistage management-including early thoracic drainage and sepsis control, followed by delayed reconstruction after nutritional rehabilitation-can achieve good long-term outcomes.
2. Successful multistage surgical management of Boerhaave syndrome: a case report and review of the literature.
This case report details a 36-year-old man with Boerhaave syndrome complicated by right hydropneumothorax, mediastinitis, and sepsis. Initial organ-preserving endoscopic stenting failed due to migration causing mediastinitis, necessitating esophagectomy and feeding jejunostomy; definitive retrosternal gastric conduit reconstruction was performed after sepsis control and nutritional rehabilitation, with eventual discharge on oral feeding.
Impact: Illustrates a practical, staged surgical strategy for complex Boerhaave syndrome with sepsis, showing that delayed reconstruction after sepsis control and nutritional optimization can yield good outcomes—useful guidance for thoracic surgeons and intensivists facing similar cases.
Clinical Implications: For patients with Boerhaave syndrome complicated by hydropneumothorax and mediastinitis, early thoracic drainage and sepsis control are critical; organ-preserving stenting can be attempted but clinicians must monitor for stent migration and be prepared to escalate to esophagectomy with staged reconstruction once infection is controlled and nutrition improved.
Key Findings
- Initial organ-preserving strategy using endoscopic esophageal stent failed due to stent migration, resulting in mediastinitis and sepsis.
- Early thoracic drainage and control of sepsis were essential to stabilize the patient before definitive reconstruction.
- Delayed definitive reconstruction (retrosternal gastric conduit pull-up) after nutritional rehabilitation led to discharge on oral feeding and good long-term outcome in this case.
Methodological Strengths
- Detailed stepwise clinical timeline including imaging, endoscopic intervention, surgical procedures, and ICU course.
- Integration of surgical decision-making with infection control and nutritional management, providing practical procedural detail.
Limitations
- Single case report limits generalizability and does not allow comparison between management strategies.
- Exact durations of ICU and long-term unit stays and long-term functional outcomes beyond discharge are not quantified.
Future Directions: Larger case series or prospective cohorts should compare organ-preserving strategies (stenting) versus early definitive surgery, define optimal timing for reconstruction after sepsis control, and quantify functional outcomes and quality of life after staged management.
BACKGROUND: Boerhaave's syndrome is a rare cause of spontaneous transmural esophageal perforation and carries high morbidity and mortality, as its classical presentation (such as Mackler's triad of vomiting, chest pain, and subcutaneous emphysema) is infrequent and diagnosis is often delayed. Early diagnosis and urgent intervention are needed. CASE PRESENTATION: This case report presents a 36-year-old Asian male admitted to the emergency department with acute chest pain and respiratory distress after multiple episodes of vomiting. Thoracic computed tomography (CT) revealed distal esophageal perforation with right hydropneumothorax. The patient was managed surgically, initially with pleural drainage and endoscopic esophageal stenting as an organ-preserving strategy, but migration of the stent with mediastinitis and sepsis necessitated esophagectomy and feeding jejunostomy. Definitive management with retrosternal gastric conduit pull-up and esophageal reconstruction was performed once sepsis was controlled and nutritional status improved, and after a prolonged stay in the long-term care unit and intensive care unit (ICU), the patient was discharged in good clinical condition on oral feeding. CONCLUSIONS: Boerhaave's syndrome is a rare but potentially life-threatening cause of esophageal perforation, particularly when complicated by massive hydropneumothorax and mediastinitis. This case illustrates that aggressive, multidisciplinary, multistage management-including early thoracic drainage and sepsis control, followed by delayed reconstruction after nutritional rehabilitation-can achieve good long-term outcomes.
3. Successful multistage surgical management of Boerhaave syndrome: a case report and review of the literature.
This case report details a 36-year-old man with Boerhaave syndrome complicated by right hydropneumothorax, mediastinitis, and sepsis. Initial organ-preserving endoscopic stenting failed due to migration causing mediastinitis, necessitating esophagectomy and feeding jejunostomy; definitive retrosternal gastric conduit reconstruction was performed after sepsis control and nutritional rehabilitation, with eventual discharge on oral feeding.
Impact: Illustrates a practical, staged surgical strategy for complex Boerhaave syndrome with sepsis, showing that delayed reconstruction after sepsis control and nutritional optimization can yield good outcomes—useful guidance for thoracic surgeons and intensivists facing similar cases.
Clinical Implications: For patients with Boerhaave syndrome complicated by hydropneumothorax and mediastinitis, early thoracic drainage and sepsis control are critical; organ-preserving stenting can be attempted but clinicians must monitor for stent migration and be prepared to escalate to esophagectomy with staged reconstruction once infection is controlled and nutrition improved.
Key Findings
- Initial organ-preserving strategy using endoscopic esophageal stent failed due to stent migration, resulting in mediastinitis and sepsis.
- Early thoracic drainage and control of sepsis were essential to stabilize the patient before definitive reconstruction.
- Delayed definitive reconstruction (retrosternal gastric conduit pull-up) after nutritional rehabilitation led to discharge on oral feeding and good long-term outcome in this case.
Methodological Strengths
- Detailed stepwise clinical timeline including imaging, endoscopic intervention, surgical procedures, and ICU course.
- Integration of surgical decision-making with infection control and nutritional management, providing practical procedural detail.
Limitations
- Single case report limits generalizability and does not allow comparison between management strategies.
- Exact durations of ICU and long-term unit stays and long-term functional outcomes beyond discharge are not quantified.
Future Directions: Larger case series or prospective cohorts should compare organ-preserving strategies (stenting) versus early definitive surgery, define optimal timing for reconstruction after sepsis control, and quantify functional outcomes and quality of life after staged management.
BACKGROUND: Boerhaave's syndrome is a rare cause of spontaneous transmural esophageal perforation and carries high morbidity and mortality, as its classical presentation (such as Mackler's triad of vomiting, chest pain, and subcutaneous emphysema) is infrequent and diagnosis is often delayed. Early diagnosis and urgent intervention are needed. CASE PRESENTATION: This case report presents a 36-year-old Asian male admitted to the emergency department with acute chest pain and respiratory distress after multiple episodes of vomiting. Thoracic computed tomography (CT) revealed distal esophageal perforation with right hydropneumothorax. The patient was managed surgically, initially with pleural drainage and endoscopic esophageal stenting as an organ-preserving strategy, but migration of the stent with mediastinitis and sepsis necessitated esophagectomy and feeding jejunostomy. Definitive management with retrosternal gastric conduit pull-up and esophageal reconstruction was performed once sepsis was controlled and nutritional status improved, and after a prolonged stay in the long-term care unit and intensive care unit (ICU), the patient was discharged in good clinical condition on oral feeding. CONCLUSIONS: Boerhaave's syndrome is a rare but potentially life-threatening cause of esophageal perforation, particularly when complicated by massive hydropneumothorax and mediastinitis. This case illustrates that aggressive, multidisciplinary, multistage management-including early thoracic drainage and sepsis control, followed by delayed reconstruction after nutritional rehabilitation-can achieve good long-term outcomes.