Blunt esophageal injury in the setting of multitrauma: A case report.

Blunt esophageal injury is an unusual organ injury that has unclear clinical symptoms due to the overlap of thoracoabdominal trauma in the setting of multiple traumas. The treatment options vary depending on the patient's clinical symptoms, the extent of esophageal damage, and the time from the onset of damage to diagnosis. This article presents a case of a young male patient receiving emergency treatment after a traffic accident. Esophageal perforation was diagnosed through chest computed tomography with contrast injection and oral contrast. The article focuses on imaging characteristics and suggestive signs of blunt esophageal injury in the setting of multitrauma.

Large Esophageal Intramural Hematoma After Solid Food Ingestion in a Patient Without Identifiable Inherited or Acquired Coagulopathy.

We present the case of an elderly man without any significant medical history and not on any anticoagulant or antiplatelet therapy who presented with severe epigastric abdominal and substernal chest pain shortly after eating a baguette. He was found to have a large 15 cm dissecting intramural hematoma of the esophagus. He was managed conservatively with proton pump inhibitors. He remained stable throughout his hospitalization without evidence of an acute blood loss anemia and was discharged home. Repeat esophagogastroduodenoscopy 8 weeks after discharge showed a 5 mm scar with complete resolution of the dissecting intramural hematoma of the esophagus.

Endoluminal wound VAC therapy for the management of esophageal trauma: A case series.

Esophageal trauma is rare and associated with high morbidity and mortality. Management can be challenging. Operative intervention involves exposure of the esophageal injury followed by primary two-layer repair with or without a buttressing muscle flap and wide local drainage. Repair can be complicated by post-operative leak and esophagocutaneous fistula. Endoluminal wound VAC therapy in the management of non-traumatic and iatrogenic esophageal perforations has shown efficacy. Presented here is a case series of four patients who sustained penetrating trauma to the esophagus and were managed successfully with endoluminal wound VAC therapy following primary repair. Therefore, endoscopic placement of an endoluminal wound VAC over the site of esophageal injury can serve as a safe and effective adjunct to primary repair of penetrating esophageal trauma. This procedure allows for frequent direct visualization of the injury as it heals, controls leakage of luminal contents, and promotes granulation for local wound healing.

Non-iatrogenic esophageal trauma: a narrative review.

Background and Objective: Non-iatrogenic esophageal trauma is a rare entity that has a high morbidity and mortality. The diagnosis can often be quite challenging, however is critical to perform in a timely manner. The workup and management of non-iatrogenic trauma continues to evolve, with new innovative approaches available for both diagnosis and treatment. The aim of this narrative review is to comprehensively describe the incidence, presentation, workup, treatment approaches and outcomes of non-iatrogenic esophageal trauma. Methods: A thorough literature review was performed using full length articles available in English via PubMed between January 1, 1960 to September 30, 2021, focusing on the epidemiology, workup and treatment of non-iatrogenic esophageal trauma, including current surgical techniques. Key Content and Findings: Injuries to the cervical esophagus are more common than injuries to the thoracic esophagus, occurring more in young males, with significant racial disparity. Penetrating trauma via gunshot wounds are the most common forms of injury, followed by stab wounds and blunt trauma. Workup is multimodal and involves a combination of plain radiographs, computed tomography (CT) scans, endoscopy and fluoroscopy depending of the stability of the patient and associated injuries. Conclusions: Workup and management of non-iatrogenic esophageal trauma depends on the location and extent of esophageal injury, and can include observation, debridement and drainage, esophageal diversion, endoscopic approaches or esophagectomy, with indications, techniques and outcomes described in further detail in this review.

Management of traumatic esophageal injuries.

Traumatic esophageal perforations are rare but difficult to treat injuries. We review the principles of work-up, anatomy and treatment of cervical, thoracic and abdominal traumatic esophageal perforations. Management is dictated by location of the perforation and any concurrent injuries. The majority of cases are amenable to primary repair with flap re-enforcement. Other principles include adequate drainage around the repair, decompression of the esophagus and stomach (via nasogastric tube or gastrostomy tube) and distal enteral nutrition (feeding jejunostomy).

Esophageal emergencies: WSES guidelines.

The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank.

BACKGROUND: Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality. METHODS: This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications. RESULTS: A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical segment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly lower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical group (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade esophageal injury (OIS IV-V), hypotension on admission, and GCS <9 as independent risk factors associated with increased mortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148-0.546; p < 0.001). Injury to the thoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06-2.53; p = 0.026). CONCLUSIONS: Despite improvements in surgical technique and critical care support, the overall mortality for traumatic esophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the major independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with improved survival. TRIAL REGISTRATION: iStar, HS-16-00883.

Enfoque terapéutico en el trauma penetrante de esófago cervical / Therapeutic Approach in the Penetrating Cervical Esophageal Trauma

Introducción: Las perforaciones del esófago cervical por traumas externos son lesiones raras asociadas con una morbilidad significativa. Los mecanismos primarios son los traumatismos penetrantes por heridas de bala, cerca del 80 por ciento de los casos, seguidas de las heridas con armas cortopunzantes en el 15 al 20 por ciento. Objetivo: Describir los criterios actuales sobre la conducta y enfoque terapéutico ante el trauma penetrante de esófago cervical. Métodos: Se realizó revisión descriptiva narrativa, de fuentes primarias y secundarias que abordaron el tema durante el primer semestre del año 2021. Los criterios de selección de los artículos a examinar fueron determinados, entre otros, por el objetivo de la actual revisión. Desarrollo: El estándar diagnóstico para estas lesiones, en ausencia de inestabilidad hemodinámica, se basó en estudios como el esofagograma, la endoscopia y la tomografía. La reparación primaria con o sin reforzamiento fue la opción más utilizada, aunque las condiciones locales y tipo de lesión en esófago cervical marcan en gran medida el proceder a realizar. Conclusiones: Las lesiones traumáticas del esófago cervical son raras pero muy mórbidas. El tratamiento depende de la ubicación de la perforación y cualquier lesión concurrente. La mayoría de los casos son susceptibles de reparación primaria con refuerzo de colgajo. Otros principios del tratamiento incluyen el drenaje adecuado alrededor de la reparación, la descompresión del esófago y el estómago (mediante sonda nasogástrica o sonda de gastrostomía) y nutrición enteral distal (yeyunostomía de alimentación). El cirujano ha de ser incisivo en los esfuerzos por descubrir la lesión de forma temprana y manejarla adecuadamente(AU)

Introduction: Cervical esophageal perforations for external trauma are rare injuries associated with a significant morbidity. The primary mechanisms are penetrating trauma for gunshot wounds, accounting for about 80 percent of cases, followed by sharp weapon injuries, accounting for 15 percent to 20 percent. Objective: To describe the current criteria on the behavior and therapeutic approach to cervical esophageal penetrating trauma. Methods: A descriptive narrative review was carried out of primary and secondary sources that addressed the subject during the first semester of the year 2021. The selection criteria of the articles to be examined were determined, among others, by the objective of the current review. Development: The standard diagnosis for these lesions, in the absence of hemodynamic instability, was based on studies such as esophagogram, endoscopy and tomography. Primary repair with or without reinforcement was the most commonly used option, although local conditions and type of lesion in cervical esophagus largely mark the procedure to be performed. Conclusions: Traumatic cervical esophageal injuries are rare but very morbid. Their treatment depends on the location of the perforation and any concurrent injury. Most cases are amenable to primary repair with flap reinforcement. Other principles of treatment include adequate drainage around the repair, decompression of the esophagus and stomach (by nasogastric tube or gastrostomy tube), as well as distal enteral nutrition (feeding jejunostomy). The surgeon must be incisive in efforts to discover the injury early and manage it appropriately(AU)

The treatment of pharyngoesophageal perforation following anterior cervical spine intervention.

OBJECTIVE: We aimed to investigate the diagnostic and therapeutic approaches in pharyngoesophageal perforation (PEP) following anterior cervical spine intervention (ACSI). METHODS: We reviewed the records of four patients with PEP after ACSI. Symptoms, physical examination findings, imaging results, treatment, and follow-up characteristics were evaluated. RESULTS: All four patients had undergone ACSI for either cervical trauma or cervical disc herniation with cervical cage reconstruction. Symptoms developed within the first 10 days of the postoperative period in three patients, and in the eighth month in one patient. Mucosal defects were detected during neck exploration in three patients. Reconstruction with primary suture and a local muscle flap was utilized in two patients. Three patients were discharged 3-8 weeks after surgical treatment. CONCLUSION: In cases of PEP after ACSI, a good prognosis can be achieved when symptoms are detected in the early period and reconstruction with local muscle flap is applied.

Ileo-right hemi-colonic cervical pull-up on a non-supercharged ileocolic arterial pedicle: A technical and case report.

Esophageal reconstruction can be challenging when stomach and colon are not anatomically intact and their use as esophageal substitutes is therefore limited. Innovative individual approaches are then necessary to restore the intestinal passage. We describe a technique in which a short stump of the right hemicolon and 25 cm of ileum on a long, non-supercharged, fully mobilized ileocolic arterial pedicle were used for esophageal reconstruction to the neck. In this case, a 65 year-old male patient had accidentally indigested hydrochloric acid which caused necrosis of his upper digestive tract. An emergency esophagectomy, gastrectomy, duodenectomy, pancreatectomy and splenectomy had been performed in an outside hospital. A cervical esophagostomy and a biliodigestive anastomosis had been created and a jejunal catheter for enteral feeding had been placed. After the patient had recovered, a reconstruction of his food passage via the left and transverse colon failed for technical reasons due to an intraoperative necrotic demarcation of the colon. Our team then faced the situation that only a short stump of the right hemi-colon was left in situ when the patient was referred to our center. After intensified nutritional therapy, we reconstructed this patient's food passage with the right hemicolon-approach described herein. After treatment of a postoperative pneumonia, the patient was discharged from hospital on the 26(th) postoperative day in a good clinical condition on an oral-only diet. In conclusion, individual approaches for long-segment reconstruction of the esophagus can be technically feasible in experienced hands. They do not always require arterial supercharging or free intestinal transplantation.

[Esophagectomy with immediate reconstruction in esophageal trauma. Case report]. / Esofagectomía con reconstrucción inmediata en traumatismo de esófago. Reporte de un caso.

BACKGROUND: Noniatrogenic traumatic injuries of the esophagus are rare and are associated with considerable morbidity and mortality. This result is influenced by the time elapsed, severity of injury and concomitant organ damage. Current management is controversial. Different treatment options exist; however, choice should be individualized to obtain the best result. OBJECTIVE: To discuss the current management of esophageal trauma. CLINICAL CASE: We report the case of a 19 year-old male with a grade V esophageal injury caused by shotgun and treated by esophagectomy and immediate gastric reconstruction. CONCLUSION: Current treatment of traumatic iatrogenic esophageal injury should be individualized for a better clinical outcome.

Antecedentes: las lesiones traumáticas del esófago no iatrogénicas son raras y dan lugar a una considerable morbilidad y mortalidad. A esto contribuyen el tiempo trascurrido, la severidad de la lesión y las lesiones orgánicas concomitantes. El tratamiento actual es motivo de controversia. Existen diferentes opciones terapéuticas; sin embargo, su elección debe individualizarse para obtener el mejor resultado. Objetivo: discutir el tratamiento actual del traumatismo esofágico. Caso clínico: se comunica el caso de un paciente masculino de 19 años de edad, con lesión grado V de esófago, causada por proyectil de arma de fuego, tratada con esofagectomía y reconstrucción inmediata mediante ascenso gástrico. Conclusión: el tratamiento actual de una lesión traumática de esófago no iatrogénica debe individualizarse para obtener un mejor resultado clínico.

Esophagectomy for a traumatic esophageal perforation with delayed diagnosis.

Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.