علاج متلازمة بورهاف مع عدم الاستقرار الديناميكي الدموي أو الانثقاب غير المحدود أو الإنتان الشديد

References

• Spontaneous esophageal perforation (Boerhaave syndrome) is most often due to an abrupt increase in the esophageal pressure following a vomiting effort in the absence of relaxation of the superior esophageal sphincter.
• Surgery should be undertaken in all patients who do not meet NOM criteria (Grade 1C).
• Primary repair is the treatment of choice for EP with free perforation of the thoracic esophagus (Grade 1C).
• Management of perforation of the thoracic esophagus relies on immediate interruption of mediastinal and pleural contamination, debridement of the perforation to healthy tissue, tension-free primary repair, and adequate external drainage.
• Buttressing the esophageal repair with surrounding viable tissue (intercostal muscle flap, pleural or pericardic patch) has been recommended to decrease the risk of leakage.
• Drainage of the mediastinum and pleural cavity is required and enteral nutrition remains an essential component of the treatment plan.