Endoscopic techniques and their effectiveness in the treatment of the boerhaave´s syndrome (clinical observation)

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Abstract

Minimally invasive endoscopic methods are gradually being introduced in all areas of medicine. Esophageal surgery is no exception. Recently, endoscopic clipping of the mucous membrane for fresh ruptures, stenting of the esophagus and Vacuum Assisted Closure have been used in the treatment of injuries of the esophagus when radical surgery is impossible and purulent complications develop. As the techniques were mastered, they were introduced into the clinic. This article presents a clinical observation of the treatment of a 56-year-old patient with a spontaneous rupture of the esophagus (Boerhaave΄s syndrome), who at certain stages of treatment used certain endoscopic techniques that allowed to stabilize the patient in the early stages of treatment and preserve the esophagus and its functionality in the future. The duration of the patient΄s treatment in the clinic was 45 days. Subsequent follow-up examinations did not reveal any abnormalities in the patient΄s health that required surgical correction. This observation allowed us to look at the problem of treating this group of patients from a different angle and form new algorithms for treating patients using minimally invasive methods (6 figs, bibliography: 10 refs).

About the authors

Petr N. Zubarev

S. M. Kirov Military Medical Academy

Author for correspondence.
Email: koptata@mail.ru
ORCID iD: 0000-0003-4470-3536

M. D., D. Sc. (Medicine), Associate Professor, Associate Professor of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Ilya I. Dzidzava

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru
ORCID iD: 0000-0002-5860-3053

M. D., D. Sc. (Medicine), Assoc. Prof., the Нead of the Hospital Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Valeriy L. Belevich

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru

M. D., D. Sc. (Medicine), Senior Lecturer of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Anton O. Brednev

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru

M. D., Ph. D. (Medicine), Lecturer of the General Surgery Department

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

Vladimir A. Popov

S. M. Kirov Military Medical Academy

Email: koptata@mail.ru

Senior Resident of the Hospital Surgery Clinic

Russian Federation, bld. 6, Akademika Lebedeva str., Saint Petersburg, 194044

References

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2. Fig. 1. X-ray contrast examination of the esophagus. Leakage of contrast agent into the left pleural cavity

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3. Fig. 2. Computer tomograms (A and B) in axial projection. Bilateral hydrothorax, hydropneumothorax on the left against the background of an enteral tube and drained pleural cavities

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4. Fig. 3. Radiographs: A - when placing a stent; B - 2 days after installation. The esophagus is tight, stent migration and contrast agent leakage are not detected

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5. Fig. 4. Photos: A - VAC-therapy system; B - technical features of the tip for installing it into the mediastinum

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6. Fig. 5. Scheme of setting the VAC-system into the fistulous tract

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7. Fig. 6. Endoscopic images: A - 1st day after application of endoclips

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8. Fig. 6. Endoscopic images: B - 7th day after staged clipping of the fistulous tract

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Copyright (c) 2020 Zubarev P.N., Dzidzava I.I., Belevich V.L., Brednev A.O., Popov V.A.

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