Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection
- PDF / 619,184 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 19 Downloads / 199 Views
(2020) 15:285
CASE REPORT
Open Access
Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection Lei Liu1,2, Wenbin Wu3, Longbo Gong3 and Miao Zhang3*
Abstract Background: Non-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), is rare after chest surgery. Case presentation: A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment. Conclusions: Perioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery. Keywords: Boerhaave’s syndrome (BS), Spontaneous ruptures of the esophagus, Three-dimensional CT angiography (3D-CTA), Single port, Uniportal, Video-assisted thoracoscopic surgery (VATS)
Background Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), typically occurs after severe emesis as a highly morbid emergency condition [1]. BS accounts for about 15% of esophageal perforations, and the tears are usually located in lower third of the esophagus [2]. Contrast esophagram and computed tomography (CT) are sufficient for the diagnosis of BS. Non-intubated video-assisted thoracoscopic surgery (VATS) can be utilized to avoid ventilation-associated adverse effects, which has been reported to be technically feasible and safe [3]. The major complications of non-intubated procedure include intraoperative hypoxia, hypercapnia, and cough.
To our knowledge, the onset of contralateral esophageal rupture after lung resection without lymph node dissection is rare. Herein we presented a case of BS following severe emesis after non-intubated lung surgery. Meanwhile, the current evidence regarding the safety of non-intubated/tubeless thoracic surgery was reviewed briefly.
Case presentation The clinical data of the patient were treated anonymously for privacy concern. A 60-year-old previously healthy female non-smoker was admitted because the CT revealed a ground-glass nodule (GGN) about 0.5 cm in the left upper lobe (Fig. 1a). The serum neuron-
* Correspondence: [email protected] 3 Department of Surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons
Data Loading...
