Quality-of-life study on four patients who underwent esophageal resection and delayed reconstruction for Boerhaave's syndrome

Boerhaave's syndrome is the condition of spontaneous rupture of the esophag us as a consequence of the strain of emesis with or without predisposing es ophageal disease. It is a condition with high mortality. We describe four p atients who underwent a transthoracic esophagectomy to remove the rupture o f the intrathoracic esophagus, closure of the esophageal gastric junction, fashioning of a feeding gastrostomy, and formation of a left cervical esoph agostomy. Three patients underwent reconstruction with subcutaneous colon. We suggest that this method of management may be considered where primary r epair is impossible in those patients too ill for prolonged reconstruction or as a salvage procedure where other methods have failed. The poor quality of life after esophagectomy is improved by reconstruction. Other surgical options include covering the repaired opening with a circumferential wrap o f pleura, chest wall muscle, or omentum or closing the repair around a T-tu be of large caliber. Esophageal exclusion using absorbable staples is anoth er approach.