Esophageal Rupture secondary to Squamous Cell Carcinoma Masquerading as COVID-19: a case report

Reza Akhavan; Hamidreza Reihani; Roohie Farzaneh; Bita Abbasi; Arman Hakemi

Esophageal Rupture secondary to Squamous Cell Carcinoma Masquerading as COVID-19: a case report

Authors

Reza Akhavan A man with chest pain and dyspnea that timely diagnosed as a case of Boerhaave Syndrome
Hamidreza Reihani Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Bita Abbasi Department of Radiology, Factuly of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Arman Hakemi Department of Emergency Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

Keywords:

Boerhaave Syndrome , squamous cell carcinoma, esophageal rupture , COVID-19

Abstract

Background: Esophageal rupture, a rare but serious condition, can occur secondary to various causes, including squamous cell carcinoma. Boerhaave Syndrome is a rare disease that is caused by a sudden increase in the pressure of the esophagus or abdomen. Here we report a Boerhaave Syndrome case with esophageal rupture secondary to squamous cell carcinoma presenting with symptoms mimicking COVID-19 as an exceedingly rare occurrence.

Case presentation: In the emergency room, a 60-year-old Caucasian man with dyspnea and chest discomfort was initially directed to the COVID-19 section during the pandemic due to relevant signs. However, his history revealed no significant past medical issues. Physical examination, ECG, and standard lab tests showed no abnormalities except for a mild fever and elevated C-reactive protein. A lung CT scan, prompted by unexplained dyspnea, showed bilateral pleural effusion, pneumomediastinitis, and pneumopericarditis. Despite some COVID-19-like features, further investigation linked symptoms to esophageal rupture, likely from recent heavy weight lifting. Esophagous contrast imaging confirmed T10 vertebrae perforation. Subsequent surgery revealed esophageal squamous cell carcinoma, leading to the patient's unfortunate demise post-repair.

Conclusion: It is reported that a timely diagnosis of Boerhaave Syndrome brings good results, however, the condition is usually misdiagnosed and the treatment is delayed.

References

Turner AR, Turner SD. Boerhaave syndrome. StatPearls [Internet]. 2020.

Domosławski P. Barogenic rupture of oesophagus (Boerhaave syndrome) as diagnostic and therapeutic challenge requiring rapid and effective interdisciplinary cooperation–case report. POL PRZEGL CHIR. 2017;89(6):37-9.

Kopelman Y, Troiza A, Hebron D. Boerhaave syndrome in an elderly man successfully treated with 3-month indwelling esophageal stent. Radiology case reports. 2018;13(5):1084-6.

Yap D, Ng M, Mbakada N. A rare complication of ileostomy obstruction: Boerhaave syndrome. The Annals of The Royal College of Surgeons of England. 2018;100(8):e203-e6.

De Schipper J, Ter Gunne AP, Oostvogel H, Van Laarhoven C. Spontaneous rupture of the oesophagus: Boerhaave’s syndrome in 2008. Digestive surgery. 2009;26(1):1-6.

Khalbuss WE, Hooda S, Auger M. Cytomorphology of Boerhaave's syndrome: A critical value in cytology. CytoJournal. 2013;10.

Hudson D, Foo J, Robertson J. Rare case of dual gastrointestinal perforations. BMJ Case Reports CP. 2020;13(3):e233658.

Shredi A, Saif El Naser H, Edriss H, Nugent K. Boerhaave Syndrome-A Case Report: 1766. American Journal of Gastroenterology. 2018;113:S1007-S8.

Sahranavard M, Akhavan Rezayat A, Zamiri Bidary M, Omranzadeh A, Rohani F, Hamidi Farahani R, et al. Cardiac Complications in COVID-19: A Systematic Review and Meta-analysis. Archives of Iranian medicine [Internet]. 2021 2021/02//; 24(2):[152-63 pp.]. Available from: http://europepmc.org/abstract/MED/33636985 https://doi.org/10.34172/aim.2021.24.

Omranzadeh A, Hoseini Jebeli SM, Ghodsi A, Mahdavi Rashed M. Mediastinal epidermoid cyst in an old man with recurrent pneumonia: A case report. Journal of Cardio-Thoracic Medicine. 2020;8(3):666-9.

Shen G, Chai Y, Zhang G-F. Successful surgical strategy in a late case of Boerhaave’s syndrome. World Journal of Gastroenterology: WJG. 2014;20(35):12696.

Prosperi P, Alemanno G, Di Bella A, Ardu M, Maltinti G, Iacopini V, et al. A minimally invasive approach with a 3d imaging system for the treatment of esophageal perforation due to Boerhaave syndrome. Ann Ital Chir. 2018.

Vial CM, Whyte RI. Boerhaave's syndrome: diagnosis and treatment. Surgical Clinics. 2005;85(3):515-24.

Still S, Mencio M, Ontiveros E, Burdick J, Leeds SG. Primary and rescue endoluminal vacuum therapy in the management of esophageal perforations and leaks. Annals of Thoracic and Cardiovascular Surgery. 2018;24(4):173-9.

Okamoto H, Onodera K, Kamba R, Taniyama Y, Sakurai T, Heishi T, et al. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. Journal of thoracic disease. 2018;10(4):2206.

Hauge T, Kleven OC, Johnson E, Hofstad B, Johannessen H-O. Outcome after stenting and débridement for spontaneous esophageal rupture. Scandinavian journal of gastroenterology. 2018;53(4):398-402.

Esophageal Rupture secondary to Squamous Cell Carcinoma Masquerading as COVID-19: a case report