In which of the following conditions operative repair is favored over conservative management?
Ans. A. Boerhaave's syndromeExplanationQuestion adopted as such from bailey and love tableThe decision between operative and non-operative management depends on four factors. These are:The site of the perforation (cervical versus thoracoabdominal esophagus);The event causing the perforation (spontaneous versus instrumental);Underlying pathology (benign or malignant);The status of the esophagus before the perforation (fasted and empty versus obstructed with a stagnant residue).Nonoperative managementOperative repairSmall septic loadLarge septic loadMinimal cardiovascular upsetSeptic shockPerforation confined to mediastinumBoerhaave's syndromeCervical esophagial perforationPleura breachedPerforation by flexible endoscopePerforation of abdominal esophagusBoerhaave's syndrome:This occurs classically when a person vomits against a closed glottis. The pressure in the esophagus increases rapidly, and the esophagus bursts at its weakest point in the lower third, sending a stream of material into the mediastinum and often the pleural cavity as well. The condition was first reported by Boerhaave. A large volume of material is released into the mediastinum, which causes rapid chemical irritation in the mediastinum and pleura followed by infection if untreated.
Boerhaave's syndrome
Perforation of cervical Esophagus
Esophageal rupture confined to mediastinum
Flexible endoscopic perforation of esophagus
Oesophagus