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Spontaneous rupture of the esophagus

Boerhaven Syndrome (Boerhaave syndrome, non-traumatic rupture of the esophagus, esophageal rupture barogenny, apoplexy esophagus, "Dining esophagus") - spontaneous rupture of all layers of the wall of the esophagus , is accompanied by severe pain in the chest and (or) in epigastrium , radiate to the back. Syndrome is characterized by a disorder of swallowing , vomiting , difficulty breathing, and the development of shock [1] [2] . First described in 1724 [3] by the Dutch doctor Hermann Boerhaave [4] [5] [6] . An intravital diagnosis of this syndrome was first made by V. Myers in 1858 [7] [8] . Timely diagnosis of this serious disease is very difficult because of its rarity, variety of clinical manifestations, often simulating different pathologies from other organs, and lack of knowledge of most doctors. In the world medical literature, by 1998, slightly more than 300 cases of spontaneous rupture of the esophagus were described [9] [10] . Due to the high mortality rate and the considerable difficulty of diagnosis, a correct diagnosis is often only posthumously established at autopsy [11] .

Syndrom Burhave
ICD-10K 22.3
ICD-9530.4
DiseasesDB9168
MedlinePlus000231
eMedicinemed / 233
MeshD004939

History

Dutch doctor Herman Burhave (1668–1738), who for the first time described the spontaneous rupture of the esophagus in 1724

The spontaneous rupture of all layers of the wall of the thoracic esophagus was first described in world medical literature in 1724 by the Dutch doctor, doctor of medicine, full member of the Paris Academy of Sciences Herman Boerhaave (Herman Boerhaave, 1668-1738) [4] [6] [12] . On October 28, 1723, German Burkhave was urgently called from Leiden to the Grand Admiral of the Dutch Navy , Baron Jean Gerrit van Wassenaer. Van Wassenaer, after a heavy meal during lunch, caused vomiting, after which he suddenly had acute pain in the left half of the chest and shortness of breath. Upon arrival, Burkhavew noted that the patient had a weak filling pulse and anuria , which persisted despite the large amount of liquid he drank. Later, Burhave noted the appearance of areas of swelling of the subcutaneous tissue , with palpation of which crepitus occurred ( subcutaneous emphysema ). On October 29, 1723, 18 hours after the onset of the first symptoms, Grand Admiral Jean Gerrit van Wassenaer died [13] [14] [15] [16] .

At the autopsy of Grand Admiral, Hermann Burhave discovered a transverse rupture of all layers of the esophagus wall in the lower third of his thoracic region, particles of food accepted by the Grand Admiral (roast duck and olive oil), free gas and liquid in the left pleural cavity, and signs of purulent mediastinitis [13] [16] . Spontaneous rupture of the esophagus Burhave called a fatal esophageal disease [17] .

The most common longitudinal rupture of the esophagus, first described by I. Dryden in 1788 [18] [19] [20] .

An intravital diagnosis of this syndrome was first made by V. Myers in 1858 [7] [8] .

The first case of recovery of a patient with Burhave syndrome was described by NW Frink in 1947, his patient survived due to drainage of the pleural cavity [16] . The first successful operation to repair an esophageal rupture with Burhava syndrome was performed in the same year by British surgeon of Australian origin N. R. Barrett (NR Barrett, 1903-1979) [21] , which published a message on this subject in the British journal of medical science, the British Journal of Surgery " [13] [22] .

Epidemiology

Spontaneous breaks of the esophagus are a rare disease, they account for 2-3% of all cases of damage to the esophagus [5] [23] . Among all patients of the specialized department of thoracic surgery, spontaneous esophageal ruptures are detected in 0.25% [10] . Most often they occur in men older than 50 years [24] . 40% of the patients abused alcohol. In the medical literature, isolated cases of spontaneous rupture of the esophagus in newborns have been described (I. Aaronson et al., 1975) [19] , but in children older than one year and adolescents this disease practically does not occur [13] .

Etiology and pathogenesis

A predisposing factor for spontaneous rupture of the esophagus may be changes in the muscle layer of the esophagus wall (drug esophagitis , peptic ulcer of the esophagus due to gastroesophageal reflux disease , infectious ulcers in AIDS patients ), and the immediate cause is a sudden increase in pressure inside the esophagus with closed pharyngeal-esophageal sphincter in with negative intrathoracic pressure, which occurs in the following pathological conditions [17] [18] [20] [24] :

  • intense vomiting after heavy consumption of food, liquid and / or alcohol [5] [17] (the pressure in the stomach during vomiting can increase to 200 mm Hg) [7] , as well as eating disorders such as bulimia ;
  • repeated vomiting on the background of the functioning disorder of the vomiting center at the bottom of the fourth ventricle of the brain [19] ;
  • increased intragastric and then intraesophageal pressure when lifting heavy weights, straining during bowel movements , intense coughing , childbirth [25] , an attack of epilepsy [13] .

A conscious increase in esophageal pressure can be promoted by a conscious desire to prevent vomiting in a public place, for example at a banquet table ("banquet esophagus") [11] [23] .

 
Typical localization of the rupture of the esophagus with Burhava syndrome (marked by an arrow) is the left wall of the lower thoracic esophagus directly above the diaphragm. Legend: 1 - thoracic esophagus, 2 - diaphragm, 3 - abdominal (abdominal) esophagus, 4 - stomach

Pathological Anatomy

Spontaneous ruptures of the esophagus are distinguished by the occurrence of large defects of the esophagus wall (from 4-5 to 10-12 cm) and are most often localized in the left wall of the lower thoracic esophagus (in 90% of cases) [6] [17] [26] [27] . In the vast majority of observations, esophageal ruptures are oriented longitudinally [11] and are localized in its weakest section β€” the left wall of the epiphrenic esophagus ampulla [19] - directly above the diaphragm [18] [28] (3–6 cm above it) [26] ; damage to the cervical, mid-thoracic, and abdominal esophagus is extremely rare [24] [29] , sometimes the gap extends to the stomach and looks like a gap in the esophagus-gastric junction [19] . Studies have revealed structural features of muscle fibers in the left wall of the lower thoracic esophagus, causing the least resistance to rupture in this place, which was confirmed in an experiment carried out on human corpses by simulating an increase in intra-esophageal pressure [29] . In Burhave's syndrome, all the walls of the esophagus are ruptured (transmural rupture), in contrast to Mallory-Weiss syndrome , in which the ruptures of the mucous membrane of the abdominal esophagus and cardiac stomach caused by abundant vomiting are superficial [4] ; besides, breaks in Bourhave’s syndrome are rarely accompanied by massive bleeding [26] . When a spontaneous rupture of the esophagus, the size of the rupture of the muscular layer always exceeds the magnitude of the defect of the mucous membrane [17] [30] . In most cases, the mediastinal pleura is simultaneously damaged, resulting in a message, usually with the left pleural cavity [31] , which leads to the rapid development of pleural empyema [9] [28] . Entering the contents of the stomach into the mediastinum and pleural cavities leads to severe intoxication and high mortality [11] .

Clinical picture

The classic picture of Burhave's syndrome is characterized by the broker's triad [5] [23] :

  • vomiting of food eaten (some patients have blood in their vomit) [17] [20] [31] [32] ;
  • subcutaneous emphysema in the cervicothoracic region due to accumulation of air in the subcutaneous fatty tissue [11] [17] (in 15% [30] –30% [31] patients);
  • severe cutting pain in the chest (less often in the abdomen) [17] [31] , suddenly occurring at the time of an attack of vomiting (may resemble pain in a stomach ulcer and duodenal ulcer), which may radiate to the left upper arm and left lumbar region and grows with swallowing [6] [11] [13] .

In most cases, the syndrome manifests as shortness of breath , symptoms of shock (pallor, sometimes cyanosis, dilated pupils, weak pulse, profuse sweat, cold extremities, thirst, feeling of fear) [3] , abdominal pain , more often in the epigastrium . In the first hours after perforation , the pain symptomatology of indefinite localization dominates, in some patients with the phenomena of an β€œ acute abdomen ”, signs of purulent intoxication , mediastinitis , pleurisy begin to prevail [17] [33] .

Depending on the clinical and anatomical features, some authors distinguish 2 options for spontaneous rupture of the esophagus: thoracic (due to perforation of the thoracic esophagus, clinically manifested by pneumothorax, pneumomediastinum , and later - purulent mediastinitis and pleural empyema) and abdominal (due to rupture of the abdominal esophagus, picture of peritonitis ) [10] .

Quite often, diagnostic errors are allowed in Burhave's syndrome: spontaneous rupture of the esophagus due to the rarity of this surgical disease, a variety of clinical manifestations that often simulate various pathologies from other organs, and the lack of awareness of most doctors is taken for other diseases, most often perforated gastric ulcer or duodenal ulcer intestines , less often - acute myocardial infarction , pulmonary thromboembolism , exfoliating an aortic aneurysm and acute pancreatitis [26] .

Instrumental research

  • chest x- ray : expansion and shading of the mediastinum, pneumomediastinum, hydrothorax and hydropneumothorax , subcutaneous chest emphysema [13] [20] [30] ;
  • general abdominal radiography : free gas under the right dome of the diaphragm (when the abdominal esophagus ruptures) [24] ;
  • X-ray examination of the esophagus with a water-soluble radiopaque substance : leakage of the contrast medium beyond the contours of the esophagus - an absolute radiological sign of spontaneous rupture of the esophagus; if there is a message with the pleural cavity, the contrast agent enters it [20] [31] ;
  • esophagoscopy : informative when assessing the state of the esophagus wall and identifying the concomitant pathology of the esophagus, stomach and duodenum, however, in patients with esophageal ruptures, it is not safe, since the flow of air through the esophagus wall defect can lead to rupture of the mediastinal pleura, and if there is a rupture, the development of intense pneumothorax and acute pulmonary heart disease due to compression of the lung. Essentially, esophagoscopy can be considered relatively safe when the pleural cavity is drained, as well as during surgery [30] ;
  • computed tomography of the chest : at the rupture of the esophagus in the mediastinum, gas accumulations, horizontal fluid levels are detected; CT examination of the esophagus with a water-soluble radiopaque substance clearly defines the emergence of the contrast medium beyond the contours of the esophagus, thus establishing the localization of the esophageal rupture, length, width and direction of the fistulous passage, its relationship with the organs and anatomical structures of the mediastinum [34] [35] ;
  • ultrasound examination of the pleural cavities : the presence of free fluid in the pleural cavity [10] ;
  • ultrasound examination of the abdominal organs : the presence of a liquid component in the abdominal cavity - subphrenic and subhepatic spaces, as well as in other areas (with rupture of the abdominal esophagus) [10] .

Treatment

The main method of treatment for Burhave’s syndrome is surgery [5] [17] [20] , the tasks of which are opening and draining damage zones, intervention on the esophagus (suturing the esophagus defect with sealing of the suture line, esophageal resection), providing enteral feeding , and disabling the esophagus [27] . The scope and type of surgical treatment is determined based on the nature of changes in the walls of the esophagus and the presence of pathology of other parts of the gastrointestinal tract and other associated diseases. The time from the onset of the disease and the severity of intoxication are relative factors in determining the volume of surgery [30] , however, the best results of surgical treatment are achieved if surgery is performed within the first 24 hours from the time of rupture [36] .

A defect formed at the site of rupture of the esophagus is sutured with an atraumatic needle , and in the case of purulent inflammation that has developed at that moment, an additional cover of the esophagus suture with the bottom of the stomach (fundoplication) is carried out, an omentum , a portion of the diaphragm , bovine pericardium , muscle flap or pleura [33] ] . The food-replication cuff not only helps seal the esophagus sutures, but also prevents reflux of the contents of the stomach and provides optimal conditions for the healing of a defect in the wall of the esophagus. Suturing of the esophageal wall defect with simultaneous fundoplication and fundraphy is the best organ-preserving operation for spontaneous rupture of the esophagus [30] . In the medical literature there is a description of the case of successful closure of the esophageal-pleural fistula with Burhava syndrome using a Blackmore probe without subsequent suturing of the esophageal wall defect [28] .

In case of extensive tears (more than 5 cm), multiple defects of the esophagus, their combination with active esophageal bleeding, detection of necrotic changes in its walls, and also in the presence of a pathologically altered esophagus, resection of its thoracic section is shown, while the optimal access is abdominal cervical [10] [30] .

In the postoperative period, active drainage of the mediastinum and pleural cavities is carried out. In order to unload the esophagus and provide enteral nutrition, a gastrostomy is applied, through which a probe is passed into the small intestine to provide enteral nutrition [33] .

It is believed that it is possible to confine oneself only to conservative methods of treatment without surgical intervention in cases where the esophageal wall defect does not exceed 0.5 cm, and the contrast medium flows beyond its contour by no more than 2 cm, there are no signs of suppuration in the periophageal tissue and mediastinum. Conservative treatment is reduced to the exclusion of ingestion through the mouth, the use of enteral nutrition through a nasogastric tube (a tube passed through the nasal passage into the stomach), infusion and antibiotic therapy [9] .

Forecast

Postoperative mortality reaches 25–85% [5] [17] and is largely determined by the time that has passed since the rupture of the esophagus [27] , due to the development of severe purulent complications in late diagnosis ( cellulitis of deep neck spaces, mediastinitis, pleural empyema, sepsis , esophago-respiratory fistula , arrosive bleeding ) [9] [31] [38] .

The best results are achieved on condition of early diagnosis of Burhave syndrome and adequate surgical treatment within the first 12 hours after the break. If the intervention is delayed for more than 24 hours, mortality (even with surgical intervention) reaches 50% or more, and with a delay in adequate treatment for 48 hours, it approaches 90%. If untreated, mortality is close to 100% [4] [13] [17] .

See also

  • Mallory-Weiss syndrome
  • Spontaneous emphysema mediastinum

Notes

  1. ↑ Lazovskis I.R. Reference book of clinical symptoms and syndromes. - Second edition, revised and enlarged. - M .: Medicine , 1981. - p. 134. - 512 p. - 50 000 copies
  2. ↑ Pokrovsky V. I. Encyclopedic Dictionary of Medical Terms. - M .: Medicine , 2005. - p. 192. - 960 p. - 10 000 copies - ISBN 5-225-04645-2 .
  3. ↑ 1 2 Feldman A.I. Breaks of the esophagus // Esophagus diseases. - M .: Medgiz , 1949. - P. 82-84. - 368 s. - 5000 copies
  4. ↑ 1 2 3 4 Praveen K. Roy. Boerhaave Syndrome (Unsolved) . Medscape . WebMD LLC. The appeal date is March 24, 2013. Archived April 6, 2013.
  5. ↑ 1 2 3 4 5 6 Kochukov V.P. Spontaneous rupture of the esophagus (Burhave syndrome) (Rus.) // Surgery. Journal them. N.I. Pirogov . - M .: Media Sphere, 2012. - β„– 7 . - p . 83-84 . - ISSN 0023-1207 .
  6. ↑ 1 2 3 4 Lee M. Boerhaave's Syndrome // Encyclopedia of Gastroenterology / Edited by Leonard Johnson. - United States: Elsevier Academic Press, 2004. - Vol. 1. - p. 222-223. - ISBN 978-0-12-386860-2 .
  7. ↑ 1 2 3 Chernousov A.F., Bogopolsky P.M., Kurbanov F.S. Esophageal Surgery: A Guide for Physicians. - M .: Medicine , 2000. - p. 38-40. - 352 s. - 3000 copies - ISBN 5-225-04569-3 .
  8. ↑ 1 2 Kharkin A. A., Zhgulev D. A., Sapicheva Yu. Yu. Successful intensive care for a patient with late diagnosis of a complicated spontaneous rupture of the esophagus (clinical observation) (Rus.) // Herald of Intensive Care. - M .: Vitar-M, 2009. - β„– 2 . - p . 65-67 . - ISSN 1726-9806 .
  9. ↑ 1 2 3 4 Timerbulatov Sh. V., Timerbulatov V. M. Spontaneous rupture of the esophagus (Burhave syndrome) (rus.) // Endoscopic surgery : an article in a journal - a scientific article. - M .: Media Sphere, 2009. - β„– 6 . - p . 48-50 . - ISSN 1025-7209 . (inaccessible link)
  10. ↑ 1 2 3 4 5 6 Timerbulatov V.M., Nartaylakov M.A., Avzaletdinov A.M., Timerbulatov Sh. V. Spontaneous rupture of the esophagus (rus.) // Thoracic and cardiovascular surgery : an article in the journal - Research Article. - M .: Medicine , 2009. - β„– 2 . - p . 34β€”37 . - ISSN 0236-2791 .
  11. ↑ 1 2 3 4 5 6 Polyanko N. I., Galkin V. N., Godulyan A. V., Kanibolotsky A. A. Spontaneous rupture of the esophagus: Burkhave syndrome (rus.) // Experimental and clinical gastroenterology: an article in the journal - Research Article. - M .: Management of research projects, 2008. - No. 2 . - p . 114-116 . - ISSN 1682-8658 .
  12. ↑ Strashun I.D. , Polyakov G. A. Burkhave, trad. Burgav, Herman // Large Medical Encyclopedia: In 30 volumes / Editor-in-chief B. V. Petrovsky . - 3rd edition. - M .: Soviet Encyclopedia , 1976. - T. 3. Beklemishev - Validol. - S. 535-536. - 584 s. - 150 000 copies
  13. ↑ 1 2 3 4 5 6 7 8 Mishchenko N. Burgava Syndrome (Russian) // Medical newspaper "Health of Ukraine". - Ukraine, 2010. - No. 2 . - p . 17 .
  14. ↑ Jan Gerrit van Wassenaer (Neopr.) . Biografisch Portaal van Nederland . Date of treatment March 30, 2013. Archived on April 6, 2013.
  15. ↑ Adams BD, Sebastian BM, Carter J. Honoring the Admiral: Boerhaave-van Wassenaer's syndrome (Eng.) // Diseases of the Esophagus. - Australia: John Wiley & Sons, Incorporated, 2006. - Vol. 19 , no. 3 - P. 146-151 . - ISSN 1120-8694 . - DOI : 10.1111 / j.1442-2050.2006.00556.x .
  16. 2 1 2 3 Curci JJ, MJ Horner of Boerhaave’s syndrome, Annals of Surgery. - United States of America: JB Lippincott Company, 1976. - Vol. 183 , no. 4 - P. 401-408 . - ISSN 0003-4932 . - DOI : 10.1097 / 00000658-197604000-00013 . - PMID 1267496 .
  17. ↑ 1 2 3 4 5 6 7 8 9 10 11 12 Miroshnikov B. I., Labazanov M. M., Ananyev N. V., Bely G. A., Smirnova N. A. Spontaneous rupture of the esophagus (rus.) / / Bulletin of Surgery named I. I. Grekov . - SPb. : Eskulap, 1998. –T . 157 , No. 2 . - p . 74-75 . - ISSN 0042-4625 .
  18. ↑ 1 2 3 Vasilenko V. Kh. , Grebenyov A. L. , Salman M. M. Damage and spontaneous ruptures of the esophagus // Esophagus diseases. - M .: Medicine , 1971. - p. 252-259. - 408 s. - 10 000 copies
  19. ↑ 1 2 3 4 5 Tamulevichute DI, Vitenas A. M. Spontaneous esophageal rupture (PSA) // Diseases of the esophagus and cardia. - 2nd edition, revised and enlarged. - M .: Medicine , 1986. - S. 148-150. - 224 s. - 30 000 copies
  20. ↑ 1 2 3 4 5 6 Shalimov A. A. , Saenko V. F., Shalimov S. A. Damage to the esophagus // Esophagus Surgery. - M .: Medicine , 1975. - S. 38-50. - 368 s. - 7000 copies
  21. ↑ Norman Rupert Barrett (Neopr.) . Whonamedit? . The date of circulation is June 9, 2013. Archived June 10, 2013.
  22. Barrett NR Report of the oesophagus successfully treated by operation (English) // British Journal of Surgery. - United Kingdom: John Wiley & Sons, Incorporated, 1947. - Vol. 35 , no. 138 . - P. 216–218 . - ISSN 0007-1323 . - DOI : 10.1002 / bjs.18003513821 .
  23. ↑ 1 2 3 Kochukov V.P. Clinical case: Burhave syndrome (Rus.) // Handbook of a polyclinic physician. - M .: Media Medica, 2011. - No. 9 . - p . 59-60 .
  24. ↑ 1 2 3 4 Yurasov S.E. Spontaneous rupture of the abdominal esophagus (rus.) // Surgery. Journal them. N.I. Pirogov . - M .: Media Sphere, 1999. - β„– 4 . - p . 58 . - ISSN 0023-1207 .
  25. ↑ Bykov V.P., Sobinin O.V., Fedoseyev V.F. Alcohol intoxication and spontaneous rupture of the esophagus in the inhabitants of the Northern region (Russian) // Human Ecology: journal article - review article. - Arkhangelsk: Northern State Medical University (Arkhangelsk) of the Federal Agency for Health and Social Development, 2009. - No. 8 . - pp . 35β€”37 . - ISSN 1728-0869 .
  26. 2 1 2 3 4 De Schipper JP, Pull ter Gunne AF, Oostvogel HJ, van Laarhoven CJ Spontaneous Rupture of the Esophagus: Boerhaave's syndrome in 2008. Literature review and treatment algorithm (Eng.) // Digestive Surgery. - Switzerland: Karger AG, 2009. - Vol. 26 , no. 1 . - P. 1-6 . - ISSN 0253-4886 .
  27. ↑ 1 2 3 Ionis E. Yu., Plechev V.V., Avzaletdinov A.M., Ismagilov F. Sh., Latypov F.R., Vildanov T.D. Spontaneous rupture of the esophagus. Burhave's syndrome. Surgical treatment // Abstracts of the V International Congress "Actual directions of modern cardio-thoracic surgery." - SPb. : Association of Thoracic Surgeons of Russia, 2015. - S. 203-204. - 224 s. - 300 copies
  28. ↑ 1 2 3 Abramzon OM, Muhamadeev MB, Skorobogatykh Yu. I., Khotyan A. R. The case of successful closure of the esophago-pleural fistula in Burhave syndrome with the help of the Blackmore probe (rus.) // Thoracic and cardiac -vascular surgery : journal article - a short report. - M .: Medicine , 2010. - β„– 1 . - p . 68 . - ISSN 0236-2791 .
  29. ↑ 1 2 Korn O., OΓ±ate JC, LΓ³pez R. Anatomy of the Boerhaave syndrome (Eng.) // Surgery. - United States: Mosby, 2007. - Vol. 141 , no. 2 - P. 222-228 . - ISSN 0039-6060 .
  30. ↑ 1 2 3 4 5 6 7 Pogodina A.N. Spontaneous and hydraulic ruptures of the esophagus (Rus.) // Scientific Medical Herald of the Central Black Soil Region. - Voronezh: Voronezh State Medical Academy named after NN Burdenko , 2007. - β„– 29 . - S. 59-62 . - ISSN 1990-472X .
  31. ↑ 1 2 3 4 5 6 R. Sulimanov. Damage and spontaneous ruptures of the thoracic esophagus (Rus.) // Surgery. Journal them. N.I. Pirogov . - M .: Media Sphere, 1999. - β„– 2 . - p . 18-20 . - ISSN 0023-1207 .
  32. Ini Santini M., Fiorello A., Cappabianca S., Vicidomini G. Abbott's T-tube (Eng.) // The Journal of Thoracic and Cardiovascular Surgery. - United States: Mosby, 2007. - Vol. 134 , no. 2 - P. 539-540 . - ISSN 0022-5223 . - DOI : 10.1016 / j.jtcvs.2007.04.033 . - PMID 17662817 .
  33. ↑ 1 2 3 Zavgorodnev S.V., Kornienko V.I., Pashkov V.G., Khitov R.A., Rusyaeva T.V., Naumov A. Yu., Timofeev D.A. Spontaneous rupture of the thoracic esophagus complicated by purulent mediastinitis, bilateral hydropneumothorax, empyema of the pleura and bronchial fistula (Rus.) // Surgery. Journal them. N.I. Pirogov . - M .: Media Sphere, 2007. - β„– 4 . - p . 54-56 . - ISSN 0023-1207 . Archived on December 2, 2013.
  34. ↑ Tyurin I.E. Computed tomography of the organs of the chest cavity. - M .: Elby-SPb, 2003 .-- S. 147. - 371 p. - ISBN 5-93979-024-0 .
  35. ↑ Vyas A., Lonial K., Vyas D. Boerhaave Syndrome Presenting With Pneumomediastinum and Pneumopericardium (Eng.) // Chest. - United States: American College of Chest Physicians, 2012. - Vol. 142 , no. 4 - P. 335 . - ISSN 0012-3692 . - DOI : 10.1378 / chest.1388747 .
  36. ↑ Sutcliffe RP, Forshaw MJ, Datta G., Rohatgi A., Strauss DC, Mason RC, Botha AJ Surgical Management of the United States College of Surgeons of England. - United Kingdom: Royal Society of Medicine, 2009. - Vol. 91 , no. 5 - P. 374-380 . - ISSN 0035-8843 . - DOI : 10.1308 / 003588409X428298 .
  37. ↑ Lukicheva O. Yu., Scriabin S.A., Korelskaya M.V., Sklyarenko M.A. A clinical case of Burkhave syndrome. Closure of the esophagus defect with grafting of the diaphragmatic flap // Collection of theses of the V International Congress "Actual directions of modern cardio-thoracic surgery." - SPb. : Association of Thoracic Surgeons of Russia, 2015. - S. 214-216. - 224 s. - 300 copies
  38. ↑ Abakumov MM. Suppurative mediastinitis (rus.) // Surgery. Journal them. N.I. Pirogov . - M .: Media Sphere, 2004. - β„– 5 . - pp . 82-85 . - ISSN 0023-1207 .

Literature

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Links

  • Praveen K. Roy. Boerhaave Syndrome (Unsolved) . Medscape . WebMD LLC (03/15/2013). The appeal date is March 24, 2013. Archived April 6, 2013.
Source - https://ru.wikipedia.org/w/index.php?title= Spontaneous esophageal rupture &oldid = 101111088


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