Asploro Journal of Biomedical and Clinical Case Reports
Article Type: Case Report
Asp Biomed Clin Case Rep. 2021 Jan 09;4(1):22-29
Kaczynski RE1*, Rogers EH1, Amador-Jimenez J2, Shakir H3, Colaco R4, Battista J1
1Department of Surgery, St. John’s Episcopal Hospital, Far Rockaway, USA
2St. Georges University School of Medicine, West Indies, Grenada
3Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
4Department of Surgery, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
Corresponding Author: Rachel E. Kaczynski
Address: Department of Surgery, St. John’s Episcopal Hospital, Far Rockaway, New York 11691, USA.
Received date: 10 December 2020; Accepted date: 02 January 2021; Published date: 09 January 2021
Citation: Kaczynski RE, Rogers EH, Amador-Jimenez J, Shakir H, Colaco R, Battista J. Survival after Esophageal Rupture during the COVID Pandemic: The Evolution of a Mallory Weiss Tear to Boerhaave’s Syndrome. Asp Biomed Clin Case Rep. 2021 Jan 09;4(1):22-29.
Copyright © 2021 Kaczynski RE, Rogers EH, Amador-Jimenez J, Shakir H, Colaco R, Battista J. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Boerhaave Syndrome, Mallory-Weiss Tear, Distal Esophageal Rupture, COVID-19, Pandemic
We present the case of a 42-year-old male cirrhotic chronic alcoholic who was admitted during the height of the COVID pandemic with a large right pleural effusion. Thorough investigation revealed a large right-sided distal esophageal rupture near the gastroesophageal junction and he was diagnosed with Mallory Weiss tear converted to Boerhaave’s syndrome. He successfully underwent endoscopic placement of a covered esophageal stent, but had a protracted recovery with presumed empyema continuing to require chest tube drainage. He eventually required surgical intervention with a right thoracotomy, decortication, and wash out. Our case provides an excellent example of the risk of distraction during a global pandemic secondary to nonspecific symptomatology being attributed to COVID-19 and significant critical care requirements leading to a significant delay in diagnosis of an esophageal rupture. However, our patient is also uniquely impressive when compared to similarly published cases of Mallory Weiss conversion to Boerhaave’s Syndrome given his survival with excellent clinical outcome leading to discharge home on oral diet despite his increased risk of morbidity based on his prolonged critical illness disease course.