Boerhaave syndrome (BS) and subsequent septic mediastinitis represent a complex cascade of events from esophageal perforation to septic shock. The pathophysiology involves chemical injury, polymicrobial contamination, cytokine storm, endothelial dysfunction, coagulation disorders, and ultimately multiple organ failure. Understanding these mechanisms is crucial for proper therapeutic management that can interrupt this lethal sequence. Due to the complexity of this condition, it is almost impossible to develop a feasible treatment protocol for every situation. The article, through a literature review, evaluates the pathophysiological mechanisms, the consequences of spontaneous esophageal rupture, as well as the therapeutic techniques available for these situations. These elements are the basis of the management of spontaneous esophageal rupture, which involves adapting and customizing the treatment for each patient.

Minimally invasive esophagectomy (MIE) has become increasingly prominent in the surgical management of esophageal cancer (EC) over the past three decades. The adoption of minimally invasive techniques has significantly enhanced oncologic esophageal surgery by improving safety, achieving oncological radicality, preserving physiological function, and elevating the postoperative quality of life of the patients. The complexity of MIE lies in its technical nuances, which critically influence postoperative morbidity and, in severe cases, mortality, especially when complications evolve unchecked. These risks underscore the importance of meticulous surgical execution and perioperative management. The optimization of mediastinal lymphadenectomy and the reduction of procedure-related morbidity have consistently represented focal points of scientific inquiry and clinical refinement, posing a persistent challenge for esophageal surgeons. MIE is widely regarded as one of the most technically demanding procedures in oncologic surgery. Its advantages, however, are most evident in the postoperative phase, where reduced trauma and faster recovery are key benefits. Experienced surgical teams have introduced refinements to MIE protocols, aiming to optimize precision and reduce complication rates. This study aims to systematically synthesize the main technological advancements and innovations currently employed in the minimally invasive management of EC, presenting them in a structured classification designed to be both accessible and practical for specialists engaged in this domain.

Background and Clinical Significance: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder characterized by esophageal dysfunction and dense eosinophilic infiltration. EoE frequently evolves into a fibrostenotic phenotype, in which uncontrolled inflammation drives progressive tissue remodeling. This evolution increases the risk of complex structural complications—most commonly fixed rings and strictures, and, in rare advanced cases, deep mural injury or fistulization—substantially increasing both diagnostic and therapeutic complexity. Case Presentation: This report describes an uncommon presentation of EoE complicated by a blind-ending esophageal fistula, managed successfully through a multidisciplinary strategy integrating pharmacologic therapy, dietary modification, and endoscopic intervention. Conclusions: Nutritional support through gastrostomy, combined with multidisciplinary medical and endoscopic management, can lead to favorable outcomes in EoE complicated by esophageal fistula. Early recognition and individualized management are essential to optimize outcomes.

Background and Objectives: Cameron lesions are linear gastric erosions or ulcers that develop at the level of the diaphragmatic constriction within a hiatal hernia. They represent an underrecognized cause of chronic iron-deficiency anemia and upper gastrointestinal bleeding. This study aimed to characterize the demographic, clinical, endoscopic, and therapeutic features of Cameron lesions diagnosed at a tertiary referral digestive endoscopy center in the Republic of Moldova. Methods: This was a retrospective single-center study from Republic of Moldova conducted over a 9-year period (2017–2026). Forty-three consecutive patients with endoscopically confirmed Cameron lesions were included. All examinations were performed by a single experienced endoscopist using high-definition endoscopy systems (Olympus EVIS Exera III and Olympus EVIS X1). Demographic characteristics, hiatal hernia type and size, clinical presentation, endoscopic findings, bleeding stigmata, Helicobacter pylori status, and postoperative outcomes were analyzed. Results: The mean age of the patients was 60.4 years (range, 31–83 years), with a female predominance (65.1%; 28 women and 15 men). The distribution of hiatal hernia types was as follows: type I (axial/sliding), 32.6% (n = 14); type II (paraesophageal/rolling), 34.8% (n = 15); and type III (mixed), 32.6% (n = 14). Cameron lesions developed after failed fundoplication in three patients (6.9%) and were identified in fixed (39.5%), completely reducible (16.3%), and partially reducible (mixed) hernias (44.2%). The main indications for upper gastrointestinal endoscopy were GERD symptoms (53.4%), iron-deficiency anemia (20.9%), prophylactic or postoperative surveillance (18.6%), and overt upper gastrointestinal bleeding (7.0%). Active Cameron lesions were identified in 55.8% of patients, whereas cicatricial and mixed lesions accounted for 30.2% and 13.9%, respectively. Bleeding stigmata were classified according to Forrest as Ia (2.3%), Ib (18.6%), IIa (4.65%), IIb (11.6%), IIc (7.0%), and III (55.81%). Nine patients (20.9%) were identified with active bleeding. Importantly, Cameron lesions were also identified in small hiatal hernias (<3 cm) and in patients with recurrent hiatal hernia after failed fundoplication. Helicobacter pylori infection was detected in 25.6% (n = 11) of patients. Conclusions: This study confirms the well-established association between Cameron lesions, female sex, hiatal hernias, and gastrointestinal bleeding while providing several novel observations, including their occurrence in small hiatal hernias, diagnosis in relatively young adults, and recurrence following failed fundoplication. The findings also highlight the potential contribution of the reducible component of hiatal hernias to lesion development and emphasize the importance of meticulous inspection of the hernia sac during every upper gastrointestinal endoscopic examination.