Options in management of trauma to the esophagus
Cheadle, W.; Richardson, J.D.
Surgery Gynecology and Obstetrics 155(3): 380-384
1982
ISSN/ISBN: 0039-6087 PMID: 7112364 Document Number: 187866
Of the 19 patients with a traumatic external injury to the esophagus who were treated from 1971-1980, 15 were seen during the last 5 yr. There were 7 cervical wounds, 9 thoracic wounds and 3 abdominoesophageal wounds. The wounds were caused by gunshot in 14 patients, knife in 4 patients and blunt injury by a steering wheel in 1 patient. Most wounds were diagnosed within 2 h of admission, but significant delays occurred in diagnosing 2 wounds. Four patients died and had associated injuries, death being due to hemorrhage while on the operating table. Usually, the diagnoses in all patients were based upon a high index of suspicion due to the location of injury and were confirmed at exploration. Roentgenograms demonstrated cervical soft tissue gas in 3 patients, a suspected bullet location in 4 patients and an airfluid level in the mediastinum in 1 patient. Preoperatively, 8 patients had esophagoscopy and 3 had an esophagogram preoperatively. Both modalities gave false-negative results on 1 occasion. There was a variety of associated injuries and in no instance was there an isolated esophageal injury. Most were 2 layered repairs, reinforced by a variety of buttressing flaps. These repairs included the Nissen fundoplication in 4 patients, pleural patches in 2 patients, a diaphragmatic flap in 1 patient and a rhomboid muscle flap in 1 patient. The ideal management of a patient in stable condition included both an esophagogram and endoscopic examination preoperatively, with surgical repairs being made subsequently. All patients who survived the associated major vascular injuries recovered from the esophageal wounds and regained normal esophageal function. The 2 patients with wounds of the thoracic part of the esophagus had major morbidity postoperatively that resulted from delays in diagnosis and treatment.