Boerhaave's syndrome: 10 years experience and review of the literature.

BACKGROUND: Spontaneous oesophageal rupture, also known as Boerhaave's syndrome, is a rare condition. It has a high mortality and its management is clouded with controversy.
METHODS: A retrospective review of cases presenting to Middlemore Hospital over a period of 10 years was performed.
RESULTS: A total of eight patients were found to have spontaneous oesophageal perforation. Six were managed operatively and two were managed non-operatively. There were seven men and one woman, whose ages ranged from 37 to 80 years (median: 64 years) at presentation. Six patients underwent thoracotomy. Five patients had primary closure of oesophageal perforation, two of these with tissue reinforcement. One patient underwent lavage alone without primary closure because there was widespread inflammation from the perforation. Two of the patients were managed non-operatively. Both subsequently died. The median postoperative stay was 36 days (range: 12-60 days). There was no postoperative mortality.
CONCLUSION: Boerhaave's syndrome is rare and its management is not uniform. A review of the literature demonstrates wide disparity in management due to the rarity of the condition. Primary repair is appropriate for ruptures diagnosed early. Many are diagnosed late and T-tube drainage may be the simplest way to manage this difficult condition in this situation.