Esophageal injury in fatal rear-impact collisions

Uhrenholt, Lars; Freeman, Michael; Jurik, Anne Grethe; Jensen, Lisbeth; Gregersen, Markil; Boel, Lene Warner Thorup; Kohles, Sean S.; Thomsen, Asser H.

doi:10.1016/j.forsciint.2010.08.019

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Whiplash neck injury is characterized by severe stretch of the soft tissues of the neck anterior to the cervical spine during the hyperextension phase of the whiplash trauma [Davis 2000;Uhrenholt 2011], and is routinely classified according to the Quebec Task Force Clinical Classification, staging patients in 5 WAD grades based on the severity of signs and symptoms following whiplash (neck pain, musculoskeletal deficits, neurological deficits, and bone fractures/dislocations) [Spitzer 1995]. Although the majority of whiplash injuries demonstrate little or no evidence of severe tissue damage with diagnostic imaging, the posttraumatic tissue edema, small-scale hematoma, and microtrauma of target structures may reflect in severe dysfunction of vital neck organs, such as the esophagus, trachea, carotid artery, jugular vein and neural system [Brademann 1998;Davis 2000;Omar 2007;Uhrenholt 2011]. In our otherwise healthy patient, with no prior history of fainting spells, the alteration, or loss of consciousness upon swallowing solid foods first appeared two weeks after the whiplash injury, which strongly suggested that stretchinduced injury of mechanoreceptors and vagal fibers acquired during car accident related neck trauma might be the fundamental pathophysiological mechanism in this clinical case.…”

Section: E86mentioning

confidence: 99%

Swallow Syncope After Whiplash Neck Injury

Lipar

Vovk

Weiss

et al. 2018

HSF

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Swallow syncope is a rare dysautonomic syndrome characterized by temporary loss of consciousness upon swallowing solid foods or liquids, displaying primarily in individuals with an underlying structural or functional esophageal or cardiac pathology. However, the evidence also suggests that isolated vagal dysfunction or abnormal reactions of esophageal mechanoreceptors after mechanical irritation, demyelination, or trauma can potentially evoke a cardioinhibitory response or vasodepression upon swallowing. We present a case of a 49-year-old otherwise healthy female patient who developed swallow syncope two weeks after whiplash neck injury acquired in a rear-end collision. After no evident anatomical and/or functional cardiac or esophageal pathology was diagnosed using several diagnostic procedures, the final diagnosis was confirmed by a provocative tilt-table test while ingesting solid food. Subsequently, a dual-chamber pacemaker was implanted, relieving the patient from troublesome symptoms. Abnormal reactions of esophageal mechanoreceptors to stimuli associated with food ingestion and/or dysfunction of afferent and efferent vagal fibers due to stretch injury and related neck trauma (acquired during the car accident) may be the leading pathophysiological mechanisms of swallow syncope in our patient.

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Section: E86mentioning

confidence: 99%

Swallow Syncope After Whiplash Neck Injury

Lipar

Vovk

Weiss

et al. 2018

HSF

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“…49 In 1960, Morrison described a patient in whom hyperextension of the cervical spine had ruptured the esophagus; the patient died of me- Fig. 3.…”

Section: 48mentioning

confidence: 99%

“…43,49 In this context, it is also feasible that a microrupture to the fragile retropharyngeal mucosa specifically located in the area adjacent to the anterior arch of C-1 could occur after whiplash injuries.…”

mentioning

confidence: 99%

Retropharyngeal abscess with secondary osteomyelitis and epidural abscess: proposed pathophysiological mechanism of an underrecognized complication of unstable craniocervical injuries: case report

Goulart

Mattei²,

Fiore

et al. 2016

SPI

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Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the authors describe the case of a previously healthy and immunocompetent patient who developed a large retropharyngeal abscess with spinal osteomyelitis after a high-energy craniocervical injury. This unusual report of osteomyelitis with a delayed presentation after a high-energy traumatic injury of the craniocervical junction highlights the possibility of direct injury to a specific area in the oropharyngeal mucosa adjacent to the osteoligamentous structures of the craniocervical junction, an overall underrecognized complication of unstable craniocervical injuries.

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“…The injury can cause esophageal perforation and microrupture of the retropharyngeal mucosa, thereby acting as a source of infection to the prevertebral space. 13 To date, to the best of our knowledge, there have been no previously reported cases of cervical osteomyelitis af-ter cervical trauma and pharyngeal soft-tissue injury in the pediatric population. We describe an unusual case in which delayed cervical osteomyelitis and epidural abscess were seen after a pharyngeal soft-tissue injury due to cervical trauma in an adolescent patient.…”

mentioning

confidence: 99%

Delayed osteomyelitis resulting from an extension injury of the cervical spine: case report

Palmer

Cohen

Braffman

et al. 2017

Journal of Neurosurgery: Pediatrics

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Osteomyelitis of the cervical spine is an exceedingly rare lesion in pediatric practice and is caused by a variety of mechanisms. The authors present a case in which cervical osteomyelitis presented in a delayed manner after the patient experienced a stable cervical extension injury at the C4–5 level. On review of the original images, the authors noted a likely perforation in the retropharyngeal space. This case highlights the risk of retropharyngeal injury in cervical trauma, with the seldom-seen complication of osteomyelitis as a result.

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Esophageal injury in fatal rear-impact collisions

Cited by 12 publications

References 27 publications

Swallow Syncope After Whiplash Neck Injury

Swallow Syncope After Whiplash Neck Injury

Retropharyngeal abscess with secondary osteomyelitis and epidural abscess: proposed pathophysiological mechanism of an underrecognized complication of unstable craniocervical injuries: case report

Delayed osteomyelitis resulting from an extension injury of the cervical spine: case report

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