초록접수 현황
| 17F-155 | 포스터 발표 |
Successful Treatment using an Endoscopic Endoluminal Vacuum Therapy after Failure of Primary Closure for Boerhaave’s Syndrome
Young Eun Kim, Young Woo Do, Joon Yong Cho, Deok Heon Lee
Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, Republic of Korea
Purpose : Boerhaave’s syndrome is a destructive disease with a high mortality rate, and it still presents a therapeutic challenge. We report a 56-year-old male patient with Boerhaave’s syndrome who was successfully treated with an endoscopic endoluminal vacuum therapy (EVT).
Methods : The patient presented with hypotension and epigastric pain for 48 hours following alcohol consumption and vomiting. Esophagogastroscopy showed about 3cm length of perforation above esophagogastric junction, and Boerhaave’s syndrome was diagnosed. Primary closure was emergently performed via left posterolateral thoracotomy, but the perforation was not healed. The next step was to apply T-tube insertion into the perforated esophagus and to perform feeding jejunostomy. However, the perforated para-esophageal cavity was still left after four weeks later. We decided to apply an EVT as a second-line treatment.
Results : A Levine tube was inserted through the nose to mouth. The polyethylene sponge was trimmed to the perforated cavity size and was sutured to the tip of the tube. An endoscope forcep was used to hold the sponge and push it into the perforated cavity by experienced endoscopist. A vacuum pump was connected to provide continuous negative pressure (80-100mmHg). EVT was repeated six times during 5 weeks. The cavity was successfully sealed, as seen at the last time of EVT. The patient was resumed oral intake and discharged without further sequela. He visited outpatient clinic for 4 months with tolerable diet.
Conclusion : An EVT can be a promising and sufficient option as an alternative treatment for esophageal perforation.
Methods : The patient presented with hypotension and epigastric pain for 48 hours following alcohol consumption and vomiting. Esophagogastroscopy showed about 3cm length of perforation above esophagogastric junction, and Boerhaave’s syndrome was diagnosed. Primary closure was emergently performed via left posterolateral thoracotomy, but the perforation was not healed. The next step was to apply T-tube insertion into the perforated esophagus and to perform feeding jejunostomy. However, the perforated para-esophageal cavity was still left after four weeks later. We decided to apply an EVT as a second-line treatment.
Results : A Levine tube was inserted through the nose to mouth. The polyethylene sponge was trimmed to the perforated cavity size and was sutured to the tip of the tube. An endoscope forcep was used to hold the sponge and push it into the perforated cavity by experienced endoscopist. A vacuum pump was connected to provide continuous negative pressure (80-100mmHg). EVT was repeated six times during 5 weeks. The cavity was successfully sealed, as seen at the last time of EVT. The patient was resumed oral intake and discharged without further sequela. He visited outpatient clinic for 4 months with tolerable diet.
Conclusion : An EVT can be a promising and sufficient option as an alternative treatment for esophageal perforation.
책임저자: Deok Heon Lee
Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, Republic of Korea
발표자: Young Eun Kim, E-mail : darkzephy112@gmail.com