Combined tracheoesophageal transection after blunt neck trauma

Abstract

Survival following tracheoesophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Understanding the mechanism of the incident can be a useful adjunct in predicting the likelihood and severity of specific anatomical patterns of injuries. We discuss published literature on combined tracheoesophageal injuries after blunt neck trauma and their outcome. A search of MEDLINE for papers published regarding tracheoesophageal injury was made. The literature search identified 14 such articles referring to a total of 27 patients. Age ranged from 3-73 years. The mechanism of injury was secondary to a rope/wire in 33%, metal bar in 4% of cases and unspecified in 63%. All of the patients were managed surgically. A number of tissues were used to protect the anastomosis including pleural and sternocleidomastoid muscle flaps. There were no reported mortalities. Patients with combined tracheoesophageal injury after blunt neck trauma require acute management of airway along with concomitant occult injuries.

A Case Report of a Soldier with Combined Injuries to the Trachea and Esophagus After Blunt Neck Trauma Successfully Treated Through an Emergency Operation

“…Adequate reports are not available to estimate the frequency of this type of cases using the literature [2]. This mechanism of laryngotracheal injury is secondary to that caused by a rope/wire (33% of cases) and that caused by a metal bar (4% of cases) [3]. Quick deceleration produces a trimming power that disrupts the trachea.…”

Airway management in laryngotracheal injuries from blunt neck trauma in children

“…The mechanisms of laryngotracheal injuries from blunt neck trauma include : Rapid deceleration of a motor vehicle, causing an unrestrained passenger to be thrown forward, usually with the head extended and the neck collides with the steering wheel or dashboard, crushing the laryngeal and/or tracheal cartilages against the cervical vertebrae. Clothesline injuries to the neck while riding motorcycles, all‐terrain vehicles, or snowmobiles when the rider strikes a stationary object such as a wire fence or tree limb. Clothesline injuries can also occur in high contact sports and martial arts. Direct trauma to the neck from interpersonal violence (direct blows using fists, feet, or blunt weapons). Strangulation from hanging, ligature suffocation, or manual choking. Blunt chest trauma causing antero‐posterior compression, resulting in sudden increase in transverse diameter of the chest, lateral traction on the trachea, and linear rupture. …”

Weaning difficulty in a near hanging patient: An unusual cause

“…Strangulation has been reported to cause tracheobronchial injury with transection. [ 7 ] However, hanging causing tracheobronchial injury and formation of TOF has never been reported previously. In this case, near hanging resulted in development of TOF.…”