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.