Use of multiple covered metal esophageal stents for treatment of Boerhaave syndrome in achalasia

Post written by Theodore W. James, MD, MSc, from the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.

We describe the case of a 95-year old-woman with known achalasia who presented after vomiting forcefully and developing a perforation of the esophagus, also known as Boerhaave syndrome. In most scenarios, this is managed with emergent operation; however, the patient’s medical co-morbidities limited her surgical options. We describe the successful placement of 3 esophageal stents in a side-by-side fashion to seal the defect and allow the patient to go home with hospice.

This was a very challenging case with numerous expert opinions weighing in on the best management strategy. Ultimately, we hoped to add to the literature regarding management of this rare overlap of conditions.

In this case, the use of multiple fully covered metal esophageal stents allowed our patient to effectively transition to home hospice and allowed her to spend her remaining time with loved ones in her own house. We hope to demonstrate that in the right patient population this option may be preferable to surgical management.

Read the full article online.

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