O.N. Balykin1,2, Raykhan Md Al1,3, V.V. Bulynin1, Yu.A. Parkhisenko1, S.V. Pavlyuchenko1

1Voronezh State Medical University named after N.N. Burdenko, Voronezh

2Clinical Hospital №33 of the Federal Medical and Biological Agency, Novovoronezh

3Kashirskaya District Hospital, Kashirskoye village, Voronezh region

Balykin Oleg N. ― Postgraduate student of the Department of Specialized Surgical Disciplines of the Voronezh State Medical University named after N.N. Burdenko, the surgeon of the surgical department of the Clinical Hospital №33 of the Federal Medical and Biological Agency

10 Studencheskaya Str., Voronezh, 394036, Russian Federation, tel. +7-920-468-29-77, e-mail:, ORCID ID: 0000-0002-1050-2368, Researcher ID Web of Science: IVH-8494-2023, SPIN-code: 3410-5958

Abstract. Spontaneous rupture of the esophagus (PSA) is a disease that occurs in 2-3% of cases of esophageal damage. Clinical manifestations of PSA are nonspecific and do not allow an accurate diagnosis. Mortality from this disease is about 67%. The main causes of an unfavorable outcome include purulent mediastinitis, sepsis, pleural empyema, pericarditis, arrosia of large mediastinal vessels and multiple organ failure. Despite a wide range of clinical and instrumental research methods, early diagnosis of PSA remains a difficult problem. Our goal is to improve the results of diagnosis and surgical treatment of patients with PSA by identifying the most effective diagnostic methods and proposing a new treatment method. In the period from 1998 to 2022, 29 patients with PSA were operated in our clinic. We performed polypositional radiography for all patients (29 observations) in a stable condition. At the same time, no patient was diagnosed with Burhave syndrome. Radiography with contrast of the esophagus was performed in 25 patients, of which 18 (62%) cases were diagnosed with Burhave syndrome. Before surgery, a computed tomography of the chest was performed in 25 patients. Among these cases, no one was diagnosed with PSA in 7 patients who did not have esophageal contrast (0,00%). Among the remaining 25 patients in whom the study included esophageal contrast with water-soluble contrast agents (urographin 76%, omnipac and others), the diagnosis of PSA was made in all 25 (100%) patients. Fibroesophagogastroduodenoscopy was performed in 10 patients (34,4%), while PSA was diagnosed in 4 patients (40%). Ultrasound examination was performed before surgery in 25 patients, but no one was diagnosed with PSA. The following treatment methods were used in patients with Burhave syndrome: 1) drainage of the pleural cavity ― in 10 patients; 2) suturing of the esophageal wound ― in 9 patients, of which 2 also had fundoplication covering the wound to be sutured; 3) in patients who did not have a perforated hole sutured, a cuff was formed from the bottom of the stomach covering the perforation (fundoplication according to Chernousov) ― in 10 patients. The results of the study showed that only CT with esophageal contrast can diagnose Burhave syndrome with 100% accuracy, while other diagnostic methods are less effective. Mortality during drainage of the pleural cavity was 60% of patients. Suturing of the esophageal wall defect was ineffective in all patients, 100% of whom developed suture failure and 73% died. When using the method, when the perforating hole was not sutured, but a cuff was formed from the bottom of the stomach, covering the perforation, the mortality rate was 20%, and none of the patients in this group had a failure of the cuff seams. A nasogastric probe was used in the nutrition of patients in this group, starting from the fourth day. In conclusion, we can say that the most effective diagnostic method is CT with esophageal contrast. As a treatment, the restoration of a ruptured esophagus without suturing and the formation of a cuff from the bottom of the stomach covering the perforation, as well as drainage of the pleural cavity and nutrition through a nasogastric probe is chosen.

Key words: Burhave syndrome, spontaneous rupture esophagus, barogenic, perforation, rupture.