Prompt action saves life of man with rare condition

Sakal Times
Sunday, 25 February 2018

Pune: A 45-year-old man, while travelling from Pune to Mumbai, started vomiting severely, and felt acute chest pain and breathlessness. It was found that he had consumed alcohol before the journey. His symptoms indicated a rare condition, Boerhaave syndrome or spontaneous perforation of the food pipe or oesophagus following forceful vomiting. The man was taken to Apollo Hospital in state of collapse for surgery was performed immediately, which saved his life.

Pune: A 45-year-old man, while travelling from Pune to Mumbai, started vomiting severely, and felt acute chest pain and breathlessness. It was found that he had consumed alcohol before the journey. His symptoms indicated a rare condition, Boerhaave syndrome or spontaneous perforation of the food pipe or oesophagus following forceful vomiting. The man was taken to Apollo Hospital in state of collapse for surgery was performed immediately, which saved his life.

Speaking to Sakal Times, Dr Shalin Dubey, General and Laparoscopic Surgeon, Apollo Hospital, Navi Mumbai, said that most patients suffering from Boerhaave syndrome are diagnosed late due to which the damage is done and the patient cannot be saved.

"However, in this case, the patient was diagnosed as soon as he was brought to us. This condition happens after the food pipe is ruptured due to forceful vomiting," said Dubey.

He further added that the patient's reflexes are suppressed due to the alcohol intake and when they vomit, excessive pressure is generated in the food pipe, which causes it to perforate.

"When perforation occurs and treatment is not given on time, it leads to early complications with a very high mortality rate. It requires immediate surgical intervention, as untreated cases can rapidly progress to infectious mediastinitis, which is inflammation of tissues in the mid-chest region and septic shock within 24-48 hours," said Dubey.

"After examination, tests and diagnosis of Boerhaave syndrome, he was taken in for immediate surgery, which is the gold standard treatment. Since the perforation had happened in the last 24 hours, it was an early perforation and was treated with a reinforced primary repair. The surgery was successful and the patient recovered well. He was discharged after a few days," said Dubey.

Early diagnosis helps
* This case demonstrates the importance of early diagnosis in an emergency so that the correct treatment can be given immediately to save lives.
* The best outcomes in Boerhaave syndrome are from early diagnosis and definitive surgical management within 12 to 24 hours of rupture.
* If treatment is delayed longer than 24 hours, the mortality rate, even with surgical intervention, rises to higher than 50 per cent, and to nearly 90 per cent after 48 hours. Left untreated, the mortality rate is close to 100 per cent. 

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