Recurrent pericardial syndromes following Boerhaave’s syndrome: a complex clinical presentation and case report

TL;DR

A rare case of recurring heart lining issues after a spontaneous esophageal rupture highlights the need for early surgical intervention when medical treatments fail.

Contribution

This case report presents a rare clinical scenario and emphasizes the role of surgical management in refractory pericardial syndromes following Boerhaave’s syndrome.

Findings

Medical therapy failed to prevent recurrent pericardial effusions and tamponade in this patient.

Pericardiectomy was required to address persistent inflammation and adhesions.

Early surgical consultation improved outcomes in this complex case.

Abstract

Recurrent pericardial syndromes secondary to Boerhaave’s syndrome (spontaneous oesophageal rupture) are exceedingly rare and represent diagnostic and therapeutic challenges.

We present a case of a 46-year-old male with recurrent pericardial effusions and cardiac tamponade following Boerhaave’s syndrome. Initial management included surgical repair of the oesophageal rupture and medical treatment for the subsequent effusions with colchicine, non-steroidal anti-inflammatory drugs, and corticosteroids. The patient experienced multiple recurrences despite medical therapy, necessitating a multidisciplinary approach. Ultimately, a pericardiectomy was performed, revealing significant pericardial adhesions and inflammation. Post-operative recovery was uneventful with recurrence of effusion.

This case underscores the importance of early recognition and multidisciplinary management in recurrent pericardial syndromes associated with oesophageal rupture. While first-line medical therapy can be effective, persistent or refractory cases may require surgical intervention. Early surgical consultation should be considered when medical management fails.

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