Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, “blind” mediastinal drainage. The second group (n=23) consisted of patients treated with “programmed re-thoracotomy”. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's χ2 test.

Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis — 1.5 times, mortality — almost 2 times.

Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Full Text

Restricted Access

About the authors

D V Senichev

Yaroslav-the-Wise Novgorod State University

Author for correspondence.
Russian Federation, Veliky Novgorod, Russia

R A Sulimanov

Yaroslav-the-Wise Novgorod State University

Russian Federation, Veliky Novgorod, Russia

R R Sulimanov

Yaroslav-the-Wise Novgorod State University

Russian Federation, Veliky Novgorod, Russia

E S Spassky

Yaroslav-the-Wise Novgorod State University

Russian Federation, Veliky Novgorod, Russia

S A Salekhov

Yaroslav-the-Wise Novgorod State University

Russian Federation, Veliky Novgorod, Russia


  1. Rabadanov K.M. Spontaneous rupture of the esophagus. Khirurgiya. Zhurnal im. N.I. Pirogova. 2014; (6): 81–83. (In Russ.)
  2. Burmistrov M.V., Trishin E.V., Matveev V.Yu., Maleev M.V., Staroverov I.N., Druzhkin S.G., Gopanyuk A.Yu. Boerhaave's syndrome. Mortality and possible ways to reduce it. Prakticheskaya meditsina. 2019; 17 (6-2): 47–49. (In Russ.)
  3. Shaker H., Elsayed H., Whittle I., Hussein S., Shackcloth M. The influence of the 'golden 24-h rule' on the prognosis of oesophageal perforation in the modern era. Eur. J. Cardiothorac. Surg. 2010; 38 (2): 216–222. doi: 10.1016/j.ejcts.2010.01.030.
  4. Mikheev A.V., Trushin S.N. Results of treatment for boerhaave syndrome. I.P. Pavlov Russian Medical Biological Herald. 2019; 27 (1): 66–74. (In Russ.) doi: 10.23888/PAVLOVJ201927166-74.
  5. Stolyarov S.I., Dobrov A.V., Grigoryev V.L., Lepeshkin A.P., Ryzhkov R.V. Spontaneous ruptures of the esophagus: issues of diagnosis and treatment. Zdravoohranenie Chuvashii. 2018; (2): 53–60. (In Russ.)
  6. Nakano T., Onodera K., Ichikawa H., Kamei T., Taniyama Y., Sakurai T., Miyata G. Thoracoscopic primary repair with mediastinal drainage is a viable option for patients with Boerhaave's syndrome. J. Thorac. Dis. 2018; 10 (2): 784–789. doi: 10.21037/jtd.2018.01.50.
  7. Yamashita S., Takeno S., Moroga T., Kamei M., Ono K., Takahashi Y., Yamamoto S., Kawahara K. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave's syndrome). Hepatogastroenterology. 2012; 59 (115): 745–746. doi: 10.5754/hge10025.
  8. Connelly C.L. Outcomes following Boerhaave’ syndrome. Ann. R. Coll. Surg. Engl. 2013; 95 (8): 557–560. doi: 10.1308/003588413X13629960049199.
  9. Fattahi Masoom S.H., Nouri Dalouee M., Fattahi A.S., Hajebi Khaniki S. Surgical management of early and late esophageal perforation. Asian Cardiovasc. Thorac. Ann. 2018; 26 (9): 685–689. doi: 10.1177/0218492318808199.
  10. Lucendo A.J., Friginal-Ruiz A.B., Rodríguez B. Boerhaave's syndrome as the primary manifestation of adult eosinophilic esophagitis. Two case reports and a review of the literature. Dis. Esophagus. 2011; 24 (2): E11–Е15. doi: 10.1111/j.1442-2050.2010.01167.x.
  11. Feldman A.I. Razryvy pishchevoda. Bolezni pishchevoda. (Ruptures of the eso¬phagus. Diseases of the esophagus.) M.: Medgiz. 2018; 368 p. (In Russ.)
  12. Abakumov M.M. Mediastinit. Rukovodstvo dlya vrachey. (Mediastinitis. A guide for doctors.) M.: MK. 2020; 296 p. (In Russ.)
  13. Rayhan M., Bulynin V.V., Zhdanov A.I., Parkhisenko Yu.A., Leibovich B.E. A new method of Boerhaave syndrome surgical treatment and its experimental justification. Vestnik eksperimentalnoy i klinicheskoy khirurgii. 2018; 11 (3): 193–201. (In Russ.) doi: 10.18499/2070-478X-2018-11-3-193-201.
  14. Danie¬lian Sh.N., Abakumov M.M., Vilk A.P., Saprin A.A., Tatarinova E.V. Risk factors of suppurative complications in case of thoracic injury. Hirurgiya. Zhurnal im. N.I. Pirogova. 2015; (7): 13–19. (In Russ.) doi: 10.17116/hirurgia2015713-19.
  15. Reardon E.S., Martin L.W. Boerhaave's syndrome presenting as a mid-esophageal perforation associated with a right-sided pleural effusion. J. Surg. Case Rep. 2015; 11: rjv142. doi: 10.1093/jscr/rjv142.
  16. Misiak P., Galazkowski R., Jablonski S. Esophageal perforation due to blunt trauma-how to diagnose and how to treat. Emerg. Med. Serv. 2016; 1: 52–53.
  17. Abbas G., Schuchert M.J., Pettiford B.L., Pennathur A., Landreneau J., Landreneau J., Luketich J.D., Landreneau R.J. Contemporaneous management of esophageal perforation. Surgery. 2009; 146 (4): 749–756. doi: 10.1016/j.surg.2009.06.058.
  18. Lee M. Boerhaave's syndrome. In: Encyclopedia of gastroenterology. 1st ed. Elsevier Academic Press. 2004; 222–223. doi: 10.1016/B0-12-386860-2/00090-3.
  19. Babaev Sh.M., Kubachev K.G. Buerhave syndrome. Vestnik eksperimentalnoy i klinicheskoy khirurgii. 2019; 12 (2): 92–96. (In Russ.) doi: 10.18499/2070-478X-2019-12-2-92-96.
  20. Stolyarov S.I., Danilov V.V. Preventive mediastinotomy for descending odontogenic mediastinitis. Zdorov'e. Me¬ditsinskaya ekologiya. Nauka. 2017; (2): 74–76. (In Russ.) doi: 10.5281/zenodo.827444.
  21. Mu¬sabaev N.H. Choice of tactics of surgical treatment of eso¬phageal injuries. Vestnik Kazakhskogo natsional'nogo meditsinskogo universiteta. 2015; (4): 238–242. (In Russ.)
  22. Afifi I., Zarour A., Al-Hassani A., Peralta R., El-Menyar A., Al-Thani H. The challenging buried bumper syndrome after percutaneous endoscopic gastrostomy. Case Rep. Gastroenterol. 2016; 10 (2): 224–232. doi: 10.1159/000446018.
  23. Lee C.C., Ravindranathan S., Choksi V. Intraoperative gastric intramural hematoma: A rare complication of percutaneous endoscopic gastrostomy. Am. J. Case Rep. 2016; 17: 963–966. doi: 10.12659/ajcr.901248.
  24. Yuruker S., Koca B., Karabicak I., Kuru B., Ozen N. Percutaneous endoscopic gastrostomy: Technical problems, complications, and management. Indian J. Surg. 2015; 77 (Suppl. 3): 1159–1164. doi: 10.1007/s12262-015-1227-6.
  25. Qureshi A.Z., Jenkins R.M., Thornhill T.H. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding during neurorehabilitation. Ifs, ands, or buts. Neurosciences (Riyadh). 2016; 21 (1): 69–71. doi: 10.17712/nsj.2016.1.20150013.
  26. Sulimanov R.A., Salekhov S.A., Egorov A.S., Mokhsin M. A method for preventing the failure of sutures of defects in the wall of the lower third of the esophagus. Patent for invention RF No. 2274422. Bulletin issued at 21.05.2004. (In Russ.)
  27. Sulimanov R.A., Senichev D.V., Sulimanov R.R. Method of surgical treatment of diffuse purulent mediastinitis. Patent for invention RF No. 2318454. Bulletin issued at 10.03.2008. (In Russ.)
  28. Sulimanov R.A., Sulimanov R.R., Bondarenko S.V., Novikov V.D., Senichev D.V., Rabanal-Karauncho Yu.D. A method of temporary fixation of ribs during programmed retoracotomy and a device for its implementation. Patent for invention RF No. 2474389. Bulletin issued at 25.05.2011. (In Russ.)

Supplementary files

Supplementary Files
1. Рис. 1. Схема наложения кисетного внутрипросветного шва на слизистую оболочку пищевода через дефект его стенки.

Download (20KB)
2. Рис. 2. Схема назоэзофагогастрального зонда

Download (21KB)
3. Рис. 3. Схема методики для профилактики несостоятельности швов при зашивании дефекта нижней трети пищевода

Download (48KB)

© 2021 Eco-Vector

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies