Conservative treatment of Boerhaave's syndrome in the elderly: Case report [Trattamento conservativo della sindrome di Boerhaave nell'anziano]

Despite of the important progress in thoracic surgery, the treatment of esophageal perforation remain a discussed and controversial argument. A woman of 83 years old, was admitted to hospital for epigastric pain arised since 24 hours with nausea, emesis and fever. Initially the case was suggesting for a cholecistitis; after four days we assisted to an aggravation of symptomathology associated with cervical emphisema. The thoracic CT response was "a mediastinitis due to a rupture of the esophagus". Medical treatment was total parenteral nutrition and best performed antibiotic therapy. The patient had a slow improvement until complete recovery. At the beginning, symptomathology was prevalently abdominal (biliary colic and emesis); for this reason, diagnosis was done when mediastinitis was already established and surgical treatment was very dangerous. In conclusion the Boerhaave's Syndrome is a rare pathology and it can starts with an unclear symptomathology. When diagnosis is late, surgical treatment is extremely dangerous and sometimes, we may obtained good results with conservative therapy.