Case Reports
Vol. 4 No. 1 (2026)
https://doi.org/10.4081/crest.2026.56

Multidisciplinary management of complicated Boerhaave syndrome: case report and systematic review of the literature

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Published: 15 May 2026
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Boerhaave syndrome, spontaneous esophageal rupture, esophageal perforation, multidisciplinary treatment, team-based care

Authors

Rebecca Filios
rebecca.filios01@universitadipavia.it
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Giulia Delnevo
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Simone Frassini
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Jacopo Viganò
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Paola Fugazzola
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Ahmed Ghaly
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Marco Bardone
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Riccardo Corti
Unit of Interventional Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Claudia Nava
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Andrea Dagnoni
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Nikolaos Markou Pappas
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Luca Ansaloni
University of Pavia; Unit of General Surgery I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Boerhaave syndrome is a rare and potentially fatal condition caused by spontaneous esophageal rupture. Although early surgical repair is generally preferred, alternative approaches, including endoscopic stenting, minimally invasive surgery, or conservative management, have increasingly been adopted in selected patients. We report a complex clinical case and present a systematic review focusing on the multidisciplinary management of Boerhaave syndrome. A 59-year-old male presented with acute chest pain after vomiting. Contrast-enhanced computed tomography (CT) revealed pneumomediastinum, bilateral pleural effusions, and a peri-esophageal fluid collection. Endoscopy confirmed a posterior esophageal perforation. The patient underwent emergency endoscopic stenting, laparoscopic esophageal repair, mediastinal debridement, gastrostomy, and jejunostomy. Postoperative complications included mediastinitis, bilateral pneumonia, and esophago-pleural fistula. Additional interventions, including video-assisted thoracoscopic surgery (VATS), percutaneous drainage, and fistula embolization, were required. The patient ultimately fully recovered and was discharged in stable condition. A systematic literature review was conducted using the PubMed, Scopus, and Web of Science databases. Studies reporting clinical outcomes of surgical, endoscopic, minimally invasive, conservative, or combined multidisciplinary treatment of spontaneous esophageal perforation were included. Twelve studies were incorporated into a narrative synthesis. The primary outcome was mortality; secondary outcomes included morbidity, need for reintervention, infection, and length of hospital stay. Early diagnosis and treatment were consistently associated with improved survival, whereas delayed diagnosis was linked to higher mortality. Surgical repair with adequate drainage remained central in early or septic presentations. Minimally invasive and endoscopic approaches demonstrated favorable outcomes in selected patients when integrated into multidisciplinary pathways. This study supports individualized, multidisciplinary management of Boerhaave syndrome, integrating surgical, endoscopic, and radiologic strategies to optimize outcomes.

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Multidisciplinary management of complicated Boerhaave syndrome: case report and systematic review of the literature. (2026). Case Reports in Emergency Surgery and Trauma, 4(1). https://doi.org/10.4081/crest.2026.56
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