Reviewer's report
Title:Chronic Presentation of Boerhaave's Syndrome
Version: 1Date:11 September 2009
Reviewer: John Plukker
Reviewer's report:
Most patients with a Boerhaave syndrome presents with acute lower chest pain
with epigastric tenderness shortly after excessive vomiting followed by
mediastinal or subcutaneous emphysema, the so-called Meckler’s triad.
Sometimes, usually when the rupture is confined to the mediastinum the
symptoms may be mild and the patient not that sick with normal vital signs and
absence of septic signs, till progression of symptoms after some period.
History and radiographic examination i.e plain chest radiographs showing
mediastinal or free air with widened mediastinum are the cornerstone of the early
diagnosis for this syndrome. In the more early cases water soluble contrast
radiographic examination still is the gold standard. This can also be performed
with contrast CT for localisation. Endoscopic localisation may cause further
rupturing and is only recommended in combination with stenting. In absence of
signs or suspicious very small tears a conservative procedure with antibiotics
could be performed. Otherwise a VATS procedure with drainge and cleaning of
mediastinal debris eventually in combination with stenting is to be prefere above
esophageal resection with cervical esophagostomy.
We have described early results of conservative methods in Selective approach
in the treatment of esophageal perforations.
Amir AI et al. Scand J Gastroenterol. 2004 May;39(5):418-22. As this report was
one of the first recommended a conservative approach with minimal morbidity
and mortality it is worthy to be mentioned.
The case report is well-written and I recommend publication with some minor
changes, as can be found above.
Reviewer's report
Title:Chronic Presentation of Boerhaave's Syndrome
Version: 1Date:11 September 2009
Reviewer: John Plukker
Reviewer's report:
Most patients with a Boerhaave syndrome presents with acute lower chest pain
with epigastric tenderness shortly after excessive vomiting followed by
mediastinal or subcutaneous emphysema, the so-called Meckler’s triad.
Sometimes, usually when the rupture is confined to the mediastinum the
symptoms may be mild and the patient not that sick with normal vital signs and
absence of septic signs, till progression of symptoms after some period.
History and radiographic examination i.e plain chest radiographs showing
mediastinal or free air with widened mediastinum are the cornerstone of the early
diagnosis for this syndrome. In the more early cases water soluble contrast
radiographic examination still is the gold standard. This can also be performed
with contrast CT for localisation. Endoscopic localisation may cause further
rupturing and is only recommended in combination with stenting. In absence of
signs or suspicious very small tears a conservative procedure with antibiotics
could be performed. Otherwise a VATS procedure with drainge and cleaning of
mediastinal debris eventually in combination with stenting is to be prefere above
esophageal resection with cervical esophagostomy.
We have described early results of conservative methods in Selective approach
in the treatment of esophageal perforations.
Amir AI et al. Scand J Gastroenterol. 2004 May;39(5):418-22. As this report was
one of the first recommended a conservative approach with minimal morbidity
and mortality it is worthy to be mentioned.
The case report is well-written and I recommend publication with some minor
changes, as can be found above.
Please review this paper.
user
Reviewer's report
Title:Chronic Presentation of Boerhaave's Syndrome
Version: 1Date:11 September 2009
Reviewer: John Plukker
Reviewer's report:
Most patients with a Boerhaave syndrome presents with acute lower chest pain
with epigastric tenderness shortly after excessive vomiting followed by
mediastinal or subcutaneous emphysema, the so-called Meckler’s triad.
Sometimes, usually when the rupture is confined to the mediastinum the
symptoms may be mild and the patient not that sick with normal vital signs and
absence of septic signs, till progression of symptoms after some period.
History and radiographic examination i.e plain chest radiographs showing
mediastinal or free air with widened mediastinum are the cornerstone of the early
diagnosis for this syndrome. In the more early cases water soluble contrast
radiographic examination still is the gold standard. This can also be performed
with contrast CT for localisation. Endoscopic localisation may cause further
rupturing and is only recommended in combination with stenting. In absence of
signs or suspicious very small tears a conservative procedure with antibiotics
could be performed. Otherwise a VATS procedure with drainge and cleaning of
mediastinal debris eventually in combination with stenting is to be prefere above
esophageal resection with cervical esophagostomy.
We have described early results of conservative methods in Selective approach
in the treatment of esophageal perforations.
Amir AI et al. Scand J Gastroenterol. 2004 May;39(5):418-22. As this report was
one of the first recommended a conservative approach with minimal morbidity
and mortality it is worthy to be mentioned.
The case report is well-written and I recommend publication with some minor
changes, as can be found above.
assistant