Current approach for Boerhaaves syndrome: A systematic review of case reports

Table 1 Descriptive comparative characteristics of all included 49 studies

Ref.	Age	Sex	Accurate diagnosis	Rupture type	Shock vital	Laceration size (cm)	Treatment	Prognosis
Jahangir et al[4], 2021	64	M	Yes	Intrapleural type	Yes	1	Stent, thoracic drainage	Death
Issa et al[23], 2019	32	M	Yes	Intrapleural type	No	2	Stent, thoracic drainage	Alive
Tan et al[5], 2022	84	M	No	Intrapleural type	No	Unknown	Thoracotomy, primary repair only	Death
Chang et al[13], 2021	67	M	Yes	Intrapleural type	No	3	Thoracopy, primary repair only, feeding jejunostomy	Alive
Chang et al[13], 2021	62	M	Yes	Intrapleural type	No	2	Thoracopy, primary repair only, feeding jejunostomy	Alive
Sheshala et al[24], 2021	39	M	No	Intrapleural type	Yes	Unknown	Stent, thoracic drainage	Alive
Matsumoto et al[25], 2019	60	M	No	Intrapleural type	Yes	Unknown	Stent, thoracic drainage	Alive
Ayazi et al[6], 2021	22	M	Yes	Intrapleural type	Yes	Unknown	Thoracotomy, esophagectomy, gastrostomy	Death
Maki et al[44], 2022	76	M	Yes	Intramediastinal type	No	7	Transhiatal approach, primary repair plus omentoplasty, feeding jejunostomy	Alive
Ioannidis et al[39], 2021	83	F	Yes	Intrapleural type	No	Unknown	Thoracic drainage	Alive
Y K et al[26], 2018	86	M	Yes	Intrapleural type	Yes	5	Stent, thoracic drainage, feeding jejunostomy	Alive
Czopnik et al[3], 2017	47	M	Yes	Intrapleural type	No	5	Transhiatal approach, primary repair, gastrostomy	Alive
Awadelkarim et al[27], 2021	36	M	Yes	Intrapleural type	Yes	2	Stent, thoracic drainage	Alive
Chalikonda et al[28], 2019	74	M	No	Intrapleural type	Yes	Unknown	Stent, thoracic drainage	Alive
Śnieżyński et al[29], 2021	53	M	Yes	Intrapleural type	No	3	Stent, thoracic drainage	Alive
Matsuura et al[21], 2022	69	M	Yes	Intramediastinal type	No	Unknown	Endoscopic clipping	Alive
Chen et al[19], 2021	57	M	No	Intramediastinal type	No	Unknown	Transhiatal approach, primary repair only, feeding jejunostomy	Alive
Truyens et al[30], 2020	66	M	Yes	Intramediastinal type	Yes	Unknown	Antibiotic administration	Alive
Truyens et al[30], 2020	77	M	Yes	Intramediastinal type	No	Unknown	Stent	Alive
Swol et al[7], 2019	70	M	Yes	Intramediastinal type	No	2	Transhiatal approach, primary repair plus fundus pauch	Death
Park et al[45], 2021	Unknown	Unknown	Yes	Intramediastinal type	No	5	Laparoscopic transhiatal approch, primary repair plus omentoplasty → endoscopic clipping, stent	Alive
Rahman et al[49], 2021	53	M	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair plus intercostal muscle pauch, gastro-jujuno tube → stent	Alive
Nachiappan et al[46], 2022	59	M	No	Intrapleural type	No	1,5	Endscopic clipping, stent → laparoscopic transhiatal approach, primary repair plus omentoplasty	Alive
Pasternak et al[14], 2019	37	M	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair only, gastrostomy	Alive
Kita et al[55], 2022	46	M	Yes	Intramediastinal type	No	4	Laparoscopic transhiatal approch, primary repair plus fundus pauch	Alive
Kita et al[55], 2022	48	M	Yes	Intramediastinal type	No	3	Laparoscopic transhiatal approch, primary repair plus fundus pauch	Alive
Kita et al[55], 2022	65	M	Yes	Intramediastinal type	No	5	Laparoscopic transhiatal approch, primary repair plus fundus pauch	Alive
Saffo et al[8], 2021	76	M	No	Intrapleural type	Yes	Unknown	Stent, thoracic drainage	Death
Kochar et al[50], 2019	40	M	Yes	Intrapleural type	Yes	Unknown	Thoracotomy, primary repair plus intercostal muscle pauch, intraoperative stent, thoracic drainage	Alive
Bury et al[51], 2022	50	M	No	Intrapleural type	No	4	Thoracotomy, primary repair plus intercostal muscle pauch, thoracic drainage	Alive
Aref et al[47], 2019	32	M	Yes	Intramediastinal type	No	2	Laparoscopic transhiatal approach, primary repair plus omentoplasty	Alive
Bani Fawwaz et al[15], 2022	63	M	Yes	Intrapleural type	Yes	3	Stent, thoracic drainage	Alive
Bani Fawwaz et al[15], 2022	56	F	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair plus T tube, Belsey fundoplication, intraoperative stent, thoracic drainage, gastrostpomy	Alive
Xu et al[22], 2021	63	M	Yes	Intrapleural type	No	Unknown	Endoscopic clipping	Alive
Tuñon et al[57], 2021	24	M	Yes	Intrapleural type	No	4	Endoluminal vacuum therapy → endoscopic clipping	Alive
Lee et al[58], 2018	52	M	Yes	Intrapleural type	No	Unknown	Thoracoscopic approach, primary repair only → endoluminal vacuum therapy, thoracic drainage	Alive
He et al[54], 2018	57	M	Yes	Intramediastinal type	No	6	Endoscopic clipping	Death
Kim et al[59], 2019	56	M	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair only → endoluminal vacuum therapy, thoracic drainage	Alive
Shennib et al[52], 2021	47	M	No	Intrapleural type	Yes	5	Thoracotomy, primary repair plus pericardial pauch, gastrostomy, feeding jejunostomy	Alive
Agrawal et al[40], 2019	26	M	No	Intrapleural type	No	Unknown	thoracic drainage	Alive
Sato et al[31], 2018	52	M	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair only → stent, thoracic drainage	Alive
Sato et al[31], 2018	53	M	No	Intrapleural type	Yes	Unknown	Stent, thoracic drainage	Alive
Ali et al[16], 2020	30	F	No	Intrapleural type	No	4	Thoracotomy, primary repair only	Alive
Anand et al[48], 2022	64	M	Yes	Intrapleural type	No	2	Thoracotomy, primary repair plus intercostal muscle pauch, thoracic drainage	Alive
Barakat et al[32], 2017	62	M	Yes	Intrapleural type	No	1	Stent, endoscopic clipping	Alive
Alakkari et al[17], 2019	69	F	Yes	Intrapleural type	No	Unknown	Thoracotomy, primary repair plus T tube	Alive
Zhu et al[18], 2021	33	M	No	Intrapleural type	No	Unknown	Stent, PEG →thoracotomy, drainage	Alive
Sekiya et al[56], 2019	61	M	Yes	Intrapleural type	No	3	Thoracoscopic and laparoscopic approach, primary repair plus pericardial pauch, gastrostomy	Alive
Sekiya et al[56], 2019	64	M	Yes	Intrapleural type	No	4	Thoracoscopic and laparoscopic approach, primary repair plus pericardial pauch, feeding jejunostomy	Alive
Olivero et al[53], 2019	67	M	No	Intrapleural type	No	2	Thoracotomy, primary repair plus pericardial pauch, thoracic drainage	Alive
Felipe et al[38], 2021	47	M	Yes	Intrapleural type	No	12	Thoracotomy and laparotomy approach, esophagostomy, gastrostomy → stent	Alive
Ahmad et al[33], 2018	63	M	Yes	Intrapleural type	No	2.5	Stent, thoracic drainage	Alive
Hashmi et al[10], 2021	83	M	Yes	Intrapleural type	Yes	Unknown	Antibiotic administration	Death
Teblick et al[34], 2018	74	M	Yes	Intrapleural type	No	Unknown	Stent, thoracic drainage	Alive
He et al[9], 2018	27	M	Yes	Intrapleural type	No	6	Thoracotomy, primary repair plus pleural flap, feeding jejunostomy	Alive

PEG: Percutaneous endoscopic gastrostomy; M: Male; F: Female.

Table 2 Characteristics of the patients with Boerhaave syndrome included in the review, n (%)

Sex		aMale 51, female 4
Age		55.8 ± 16
The length from symptom within 24 h		b36 (65.5)
The method of diagnosis	CT	31
	Esophagography	15
	Endoscopy	9
	Exploratory laparotomy	1
Accurate diagnosis on admission		42 (75)
Shock vital on admission		14 (25)
Rupture type	Intramediastinal	12 (21.4)
	Extramediatinal	44 (78.6)
Lacelation size (cm) (range)		c3.8 (1-12)

^aOne case with no information.

^bOne case with no information.

^c26 cases with no information.

CT: Computed tomography.

Table 3 Initial treatment for Boerhaave syndrome

			The number do not add up because of duplication case
Conservation (n = 25)a	Esophageal stent		17
	Clipping		5
	Thoracic drainage		21
	EVACb		1
Operation (n = 31)	Approach	Trans-thoracic approach	18
		Trans-abdominal approach	10
		Trans-thoracic and abdominal approach	3
	Method	Primary repair only	8
		Primary repair with omentoplasty	6
		Primary repair with fundus pauch	6
		Primary repair with intercostal muscle pauch	5
		Primary repair with pericardial fat pauch	5
		T tube	2
		Esophagectomy	1
		Esophagostomy and gastrostomy	1

^aDuplication exist.

^bEndoluminal vacuum-assisted therapy.

EVAC: Endoluminal vacuum-assisted.

Table 4 The length of hospital stay was not significantly different among the 43 cases

Factor	Group	Operation (n = 31)	Conservation (n = 25)	Pvalue
Sex (%)	M	27 (90.0)	24 (96.0)	0.617
	F	3 (10.0)	1 ( 4.0)
mean ± SD		53.17 (14.68)	59.00 (18.14)	0.193
The length from symptom within 24 h (%)	Yes	10 (32.3)	9 (36.0)	1
	No	20 (64.5)	16 (64.0)
Shock vital on admission (%)	Yes	3 ( 9.7)	11 (44.0)	0.005
	No	28 (90.3)	14 (56.0)
rupture type	Intramediastinal (%)	8 (25.8)	4 (16.0)	0.516
	Extramediastinal (%)	23 (74.2)	21 (84.0)
Alive (%)	Yes	28 (90.3)	21 (84.0)	0.688
	No	3 ( 9.7)	4 (16.0)

F: Female; M: Male.