How is Boerhaave’s syndrome treated?

How is Boerhaave’s syndrome treated?

Treatment follows these steps:

• IV fluids. Most people need immediate IV fluid resuscitation due to overall volume loss.
• Antibiotics. A broad spectrum of antibiotics will be given intravenously to control infection.
• Surgical consult. Surgery is the standard of care for most people. Some small, contained ruptures may qualify for observation and IV antibiotics, or treatment by endoscopy instead. But in these cases, healthcare providers will still want to have a surgical backup plan.
• Surgical repair. Ideally, the rupture should be repaired directly within 24 hours. Depending on your condition, your surgeon may be able to use a minimally invasive surgery technique like video-assisted thoracoscopic surgery (VATS). Some emergency cases may need to be managed by open thoracotomy to allow quick and thorough access to your full thoracic cavity.
• Drainage/debridement. In addition to the direct repair of the tear, any infected fluid collections in the cavity will need to be drained and sterilized, and any infected or necrotic (dead) tissue will need to be removed. In some severe cases, this may mean removing part of your esophagus.
• Advanced management. When surgery isn’t possible within 24 hours of rupture, direct repair may not work. The edges of the wound may have begun to stiffen or fray. In this case, your surgeon may need to remove part or all of your esophagus (esophagectomy). If you need an esophagus replacement, you can have one after six weeks.
• Alternative nutrition. While your esophagus is healing, you won’t be able to use it to swallow food, so you’ll need an alternative way of feeding. This might be by tube or by vein.