Boerhaave syndrome medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Its treatment includes immediate [[antibiotic|antibiotic therapy]] to prevent [[mediastinitis]] and sepsis, surgical repair of the perforation,<ref name="pmid17220586">{{cite journal |author=Matsuda A, Miyashita M, Sasajima K, ''et al.'' |title=Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report |journal=Journal of Nippon Medical School = Nihon Ika Daigaku zasshi |volume=73 |issue=6 |pages=341–5 |year=2006 |pmid=17220586 |url=http://www.jstage.jst.go.jp/article/jnms/73/6/73_341/_article|doi=10.1272/jnms.73.341}}</ref> and if there is significant fluid loss it should be replaced with [[intravenous therapy|IV fluid therapy]] since oral rehydration is not possible. Even with early surgical intervention (within 24 hours) the risk of death is 25%.<ref>{{cite journal |author=Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly JF |title=Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment |journal=Eur J Cardiothorac Surg |volume=25 |issue=4 |pages=475–9 |year=2004 |month=April |pmid=15037257 |doi=10.1016/j.ejcts.2003.12.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S1010794003008170}}</ref> | Its treatment includes immediate [[antibiotic|antibiotic therapy]] to prevent [[mediastinitis]] and sepsis, surgical repair of the perforation,<ref name="pmid17220586">{{cite journal |author=Matsuda A, Miyashita M, Sasajima K, ''et al.'' |title=Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report |journal=Journal of Nippon Medical School = Nihon Ika Daigaku zasshi |volume=73 |issue=6 |pages=341–5 |year=2006 |pmid=17220586 |url=http://www.jstage.jst.go.jp/article/jnms/73/6/73_341/_article|doi=10.1272/jnms.73.341}}</ref> and if there is significant fluid loss it should be replaced with [[intravenous therapy|IV fluid therapy]] since oral rehydration is not possible. Even with early surgical intervention (within 24 hours) the risk of death is 25%.<ref>{{cite journal |author=Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly JF |title=Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment |journal=Eur J Cardiothorac Surg |volume=25 |issue=4 |pages=475–9 |year=2004 |month=April |pmid=15037257 |doi=10.1016/j.ejcts.2003.12.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S1010794003008170}}</ref> | ||
Conservative management consists of the following: | |||
*Intravenous fluids should be instituted. | |||
*Antibiotics: Imipenem/cilastatin (Primaxin) offers good broad-spectrum coverage. | |||
*Nasogastric suction should be applied. | |||
*Keep the patient NPO. | |||
*Adequate drainage with tube thoracostomy or formal thoracotomy is vital. | |||
*Early use of nutritional supplementation: Evidence suggests that for hastening recovery, a jejunostomy tube feeding may be favored over hyperalimentation. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Its treatment includes immediate antibiotic therapy to prevent mediastinitis and sepsis, surgical repair of the perforation,[1] and if there is significant fluid loss it should be replaced with IV fluid therapy since oral rehydration is not possible. Even with early surgical intervention (within 24 hours) the risk of death is 25%.[2]
Conservative management consists of the following:
- Intravenous fluids should be instituted.
- Antibiotics: Imipenem/cilastatin (Primaxin) offers good broad-spectrum coverage.
- Nasogastric suction should be applied.
- Keep the patient NPO.
- Adequate drainage with tube thoracostomy or formal thoracotomy is vital.
- Early use of nutritional supplementation: Evidence suggests that for hastening recovery, a jejunostomy tube feeding may be favored over hyperalimentation.
References
- ↑ Matsuda A, Miyashita M, Sasajima K; et al. (2006). "Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report". Journal of Nippon Medical School = Nihon Ika Daigaku zasshi. 73 (6): 341–5. doi:10.1272/jnms.73.341. PMID 17220586.
- ↑ Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly JF (2004). "Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment". Eur J Cardiothorac Surg. 25 (4): 475–9. doi:10.1016/j.ejcts.2003.12.029. PMID 15037257. Unknown parameter
|month=ignored (help)