Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report
Abstract Background Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharynge...
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Japan Surgical Society
2018-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-018-0462-z |
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| author | Hideharu Tanaka Norihisa Uemura Daisuke Nishikawa Keisuke Oguri Tetsuya Abe Eiji Higaki Takahiro Hosoi Byonggu An Yasuhisa Hasegawa Yasuhiro Shimizu |
| author_facet | Hideharu Tanaka Norihisa Uemura Daisuke Nishikawa Keisuke Oguri Tetsuya Abe Eiji Higaki Takahiro Hosoi Byonggu An Yasuhisa Hasegawa Yasuhiro Shimizu |
| author_sort | Hideharu Tanaka |
| collection | DOAJ |
| description | Abstract Background Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome. To the best of our knowledge, this is the first report of a patient with esophageal rupture occurring during CRT for hypopharyngeal cancer with stenosis. Case presentation A 66-year-old man with a sore throat was referred to our hospital. He was found to have stage IVA hypopharyngeal cancer, cT2N2bM0, and underwent radical concurrent CRT consisting of weekly cisplatin (30 mg/m2) and radiation (70 Gy/35fr), for larynx preservation. On day 27 of treatment, he vomited, which was followed by severe left chest pain radiating to the back and the upper abdomen. Enhanced computed tomography (CT) revealed extensive mediastinal emphysema and a small amount of left pleural effusion. Esophagography revealed extravasation into the left thoracic cavity, and the patient was diagnosed with an intrathoracic rupture type of Boerhaave syndrome. He underwent emergency left thoracotomy 21 h after the onset. The ruptured esophageal wall was primarily repaired by closure with two-layer suturing and covered by a pedicled omentum. A jejunostomy tube was placed for postoperative enteral nutrition. On postoperative day (POD) 16, the patient was transferred to head and neck surgery to finish CRT and was discharged on POD 56. He has survived without relapse for 11 months after surgery. Conclusion Patients with head and neck cancer are at risk for developing Boerhaave syndrome during CRT. In addition, since such patients often are in poor overall condition because of immunosuppression and protracted wound healing, Boerhaave syndrome can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome. |
| format | Article |
| id | doaj-art-a3bdacc1307f4dceacb34301cf71563a |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2018-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-a3bdacc1307f4dceacb34301cf71563a2025-08-20T03:56:59ZengJapan Surgical SocietySurgical Case Reports2198-77932018-06-01411610.1186/s40792-018-0462-zBoerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case reportHideharu Tanaka0Norihisa Uemura1Daisuke Nishikawa2Keisuke Oguri3Tetsuya Abe4Eiji Higaki5Takahiro Hosoi6Byonggu An7Yasuhisa Hasegawa8Yasuhiro Shimizu9Department of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Head and Neck Surgery, Aichi Cancer Center HospitalDepartment of Head and Neck Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalDepartment of Head and Neck Surgery, Aichi Cancer Center HospitalDepartment of Gastroenterological Surgery, Aichi Cancer Center HospitalAbstract Background Spontaneous esophageal rupture, also known as Boerhaave syndrome, is a very serious life-threatening benign disease of the gastrointestinal tract. It is typically caused by vomiting after heavy eating and drinking. However, in our patient, because of a combination of hypopharyngeal cancer with stenosis and chemoradiotherapy (CRT), which caused chemotherapy-induced vomiting, radiotherapy-induced edema, relaxation failure, and delayed reflexes; resistance to the release of increased pressure due to vomiting was exacerbated, thus leading to Boerhaave syndrome. To the best of our knowledge, this is the first report of a patient with esophageal rupture occurring during CRT for hypopharyngeal cancer with stenosis. Case presentation A 66-year-old man with a sore throat was referred to our hospital. He was found to have stage IVA hypopharyngeal cancer, cT2N2bM0, and underwent radical concurrent CRT consisting of weekly cisplatin (30 mg/m2) and radiation (70 Gy/35fr), for larynx preservation. On day 27 of treatment, he vomited, which was followed by severe left chest pain radiating to the back and the upper abdomen. Enhanced computed tomography (CT) revealed extensive mediastinal emphysema and a small amount of left pleural effusion. Esophagography revealed extravasation into the left thoracic cavity, and the patient was diagnosed with an intrathoracic rupture type of Boerhaave syndrome. He underwent emergency left thoracotomy 21 h after the onset. The ruptured esophageal wall was primarily repaired by closure with two-layer suturing and covered by a pedicled omentum. A jejunostomy tube was placed for postoperative enteral nutrition. On postoperative day (POD) 16, the patient was transferred to head and neck surgery to finish CRT and was discharged on POD 56. He has survived without relapse for 11 months after surgery. Conclusion Patients with head and neck cancer are at risk for developing Boerhaave syndrome during CRT. In addition, since such patients often are in poor overall condition because of immunosuppression and protracted wound healing, Boerhaave syndrome can rapidly lead to severe life-threatening infections such as empyema and mediastinitis. Therefore, awareness of this condition is important so that appropriate treatment can rapidly be implemented to increase the likelihood of a good outcome.http://link.springer.com/article/10.1186/s40792-018-0462-zBoerhaave syndromeSpontaneous esophageal ruptureEsophageal perforationChemoradiotherapyHypopharyngeal cancer |
| spellingShingle | Hideharu Tanaka Norihisa Uemura Daisuke Nishikawa Keisuke Oguri Tetsuya Abe Eiji Higaki Takahiro Hosoi Byonggu An Yasuhisa Hasegawa Yasuhiro Shimizu Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report Surgical Case Reports Boerhaave syndrome Spontaneous esophageal rupture Esophageal perforation Chemoradiotherapy Hypopharyngeal cancer |
| title | Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report |
| title_full | Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report |
| title_fullStr | Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report |
| title_full_unstemmed | Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report |
| title_short | Boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer: a case report |
| title_sort | boerhaave syndrome due to hypopharyngeal stenosis associated with chemoradiotherapy for hypopharyngeal cancer a case report |
| topic | Boerhaave syndrome Spontaneous esophageal rupture Esophageal perforation Chemoradiotherapy Hypopharyngeal cancer |
| url | http://link.springer.com/article/10.1186/s40792-018-0462-z |
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