City Doctors Perform Rare Boerhaave’s Syndrome Surgery
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01 February 2011
By Umesh Isalkar
Falling severely ill in a foreign country can be a daunting experience, particularly if one does not know where to turn to for help. Fortunately for German automobile engineer H Thomas (49), on a business trip to General Motors in Talegaon, that help was forthcoming. A few months ago, Thomas suffered a rupture of the food pipe or Boerhaave‘s syndrome (oesophageal rupture following vomiting), an extremely rare but well–defined medical complication.
"Thomas, started feeling unwell after dinner and rushed to the washroom. He had a bout of vomiting and an attack of excruciating pain in the chest and collapsed," said surgeon Gajanan Wagholikar of Aditya Birla Memorial Hospital (ABMH). The alarmed staff at the hotel where Thomas was staying, first sought medical help but later, when his condition deteriorated, shifted him to the ABMH.
"Thomas was admitted in a very serious condition. He was panting for breath. Initial tests revealed large amounts of air and fluid in the chest compressing the left lung with dangerously low levels of oxygen in blood," said Wagholikar. "Immediate bedside insertion of a tube in the chest was done to clear the passage."
Wagholikar, the attending surgeon at the time of Thomas‘ admittance to the hospital, suspected an esophageal rupture. An emergency CT scan of the thorax confirmed the same and an emergency surgery (thoracotomy) was performed by a team comprising surgeons Wagholikar and Mahesh Thombare and anaesthetist Ashish Pathak.
"There was a large rent in the lower esophagus and around 2 litres of ingested food and drinks had accumulated in the chest, compressing the lungs. The tear in the esophagus was repaired and the contents drained. The patient had a stormy recovery with chest infection and rhythm disturbances of the heart which settled with medicines," Thombare said.
"Boerhaave‘s syndrome is one of the most lethal perforations of the digestive system," said Wagholikar. "It usually happens due to uncoordinated muscle contraction during vomiting. The stomach contents are forced into the chest at a high pressure during vomiting, which causes chemical damage as well as introduces infection," he added.
"Untreated, this problem is invariably fatal. It needs emergency surgery. After the first eight hours, mortality increases with every passing hour. Mortality is very high after 24 hours and when surgery is done late, as many as 50–75% patients may die because of infection and respiratory failure," he added.
"Delay in diagnosis is not unusual because of nonspecific symptoms and the rarity of this condition. Often patients get investigated for chest problems, because of the chest pain and breathlessness, and precious time is lost," Wagholikar said.
A close synergy between specialists and prompt decision–making enabled Thomas to have surgery within three hours of getting admitted. And today, after recuperating fully, he is back home with his family.