Журнал «Медицина неотложных состояний» Том 20, №4, 2024

Синдром Бурхаве є рідкісним станом із захворюваністю 3,1/1 000 000 на рік, має високий рівень смертності через пізню діагностику та труднощі в лікуванні. Мета: привернути увагу лікарів до різноманітності клінічних проявів синдрому Бурхаве, що ускладнює ранню діагностику та прийняття рішень. Наведено клінічне спостереження двох пацієнтів із синдромом Бурхаве. Один хворий госпіталізований через 7 годин після появи болю у верхньому боці зліва, нудоти, блювання. При клінічному огляді, ультразвуковій діагностиці та рентгенологічному дослідженні патології не виявлено. Проте через 3 години стан хворого різко погіршився, з’явилася емфізема шиї та грудної клітки. Рентгенологічно виявлено лівосторонній пневмогемоторакс. При торакотомії в нижній третині стравоходу на його лівій латеральній стінці виявлений розрив довжиною 3,5 см, який було зашито. Грудну порожнину та середостіння очищено і дреновано за допомогою трубок. Сформовано гастростому. Післяопераційний період ускладнився поліорганною недостатністю та сепсисом. Пацієнт перебував у відділенні інтенсивної терапії 29 днів. На 46-ту добу рана стравоходу зажила, хворий виписаний на амбулаторне спостереження. Інший пацієнт був госпіталізований через 3 години після початку захворювання з лівостороннім пневмогемотораксом та симптомами гострого живота. Встановлено грудну трубку ліворуч, під тиском виділилася темно-коричнева рідина. Клінічні симптоми перитоніту спонукали хірургів до термінової лапаротомії, під час якої патології органів черевної порожнини не виявлено. Лише при комп’ютерній томографії діагностували розрив стравоходу. Внаслідок пізньої операції розвинулись інфекційні ускладнення та сепсис, що призвело до смерті хворого.

Boerhaave’s syndrome is a rare disease with an incidence of 3.1/1,000,000 per year, has a high mortality rate due to late diagnosis and difficulty in treatment. The purpose of the message is to draw the attention of doctors to the variety of clinical manifestations of Boerhaave’s syndrome, which complicates early diagnosis and decision making. Clinical observation of two patients with Boerhaave’s syndrome is presented. One patient was hospitalized 7 hours after the onset of pain in the upper left side, nausea, vomiting. Clinical examination, ultrasound and chest X-ray revealed no pathology. However, after 3 hours, the patient’s condition deteriorated sharply, emphysema of the neck and chest appeared. X-ray revealed left-sided pneumohemothorax. Thoracotomy revealed a 3.5-cm long rupture in the lower third of the esophagus on its left lateral wall, which was sutured. The chest cavity and mediastinum are debrided and drained using tubes. A gastrostomy was formed. The postoperative period was complicated by multiple organ failure and sepsis. Patient was in the intensive care unit for 29 days. The esophageal wound healed on the 46th day and the patient was discharged for outpatient observation. Another patient was hospitalized three hours after onset of illness with a left-sided pneumohemothorax and acute abdomen symptoms. Chest tube on the left was placed and a dark brown liquid released under pressure. The peritonitis clinical symptoms prompted surgeons to perform urgent laparotomy during which no pathology of the abdominal organs was detected. Only after computed tomography, a rupture of the esophagus was diagnosed. As a result of delayed surgery, infection complications and sepsis developed, which led to the patient’s death.

синдром Бурхаве; розрив стравоходу; діагностика; лікування; огляд

Boerhaave’s syndrome; rupture of the esophagus; diagnosis; treatment; review

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