A delayed presentation of Boerhaave's syndrome with mediastinitis managed using the over-the-scope clip

Eamon Ramhamadany; Saif Mohamed; Shameen Jaunoo; T Baker; Jayan Mannath; James Harding; Vinod Menon

doi:10.1093/jscr/rjt020

A delayed presentation of Boerhaave's syndrome with mediastinitis managed using the over-the-scope clip

J Surg Case Rep. 2013 May 2;2013(5):rjt020. doi: 10.1093/jscr/rjt020.

Authors

Eamon Ramhamadany¹, Saif Mohamed², Shameen Jaunoo², T Baker², Jayan Mannath², James Harding², Vinod Menon²

Affiliations

¹ University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK er104@ic.ac.uk.
² University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.

Abstract

Boerhaave syndrome is a spontaneous perforation of the oesophagus secondary to forceful emesis. Surgery has been advocated in delayed presentations of Boerhaave's syndrome with mediastinitis. The over-the-scope clip (OTSC) by OVESCO(®) (Tubingen, Germany) has been used in the endoscopic management of gastrointestinal bleeds, fistulae and anastamotic leaks. We describe the successful endoscopic use of the OTSC in a delayed presentation of Boerhaave syndrome with mediastinitis. A 69-year-old gentleman underwent a computerised tomography scan, which demonstrated a lower oesophageal perforation and mediastinitis 7 days after admission, having presented with forceful emesis and chest discomfort. During endoscopy the defect was visualized and successfully closed using the OTSC. This resulted in a favourable outcome and is a technique not previously described in the literature to manage this condition.

Publication types

Case Reports