Boerhaave syndrome
ICD-10 K22.3 · ICD-11 DA20.30

Boerhaave Syndrome with Hemodynamic Instability or Severe Sepsis: When Surgery Cannot Be Avoided

Spontaneous esophageal perforation (Boerhaave syndrome) typically results from an abrupt rise in esophageal pressure — most often after a vomiting effort — and can escalate rapidly to a life-threatening emergency. When the presentation includes hemodynamic instability, non-contained extravasation of contrast material, or systemic signs of severe sepsis, the patient does not meet criteria for non-operative management and requires urgent surgical intervention.

Clinical scenario

Spontaneous (Boerhaave) esophageal perforation presenting with one or more of the following: hemodynamic instability, non-contained extravasation of contrast material on imaging, or systemic signs of severe sepsis. These features indicate that non-operative management criteria are not met, and surgery should be undertaken.

Approach (partial overview)

When direct repair of the thoracic esophagus is not feasible — due to the severity of the presentation or the extent of esophageal damage — the surgical strategy may involve esophageal exclusion, diversion, or resection.

Full procedural details, decision criteria, and step-by-step guidance are available in the structured protocol →
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1186/s13017-019-0245-2

  • 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).
  • If direct repair of thoracic EP is not feasible (hemodynamic instability, delayed surgical exploration, extensive esophageal damage) esophageal exclusion, diversion, or resection should be performed (Grade 1C).
  • Complete esophageal diversion or thoracic esophageal resection is required in the presence of large esophageal disruption; creation of a cervical esophagostomy and feeding jejunostomy are mandatory in these patients.
View source ↗