Survival after Esophageal Rupture during the COVID Pandemic: The Evolution of a Mallory Weiss Tear to Boerhaave’s Syndrome

Kaczynski RE^1*, Rogers EH¹, Amador-Jimenez J², Shakir H³, Colaco R⁴, Battista J^1
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

Abstract

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.