Intrathoracic esophageal rupture distal to the carina after blunt chest trauma: Case-report

Abstract

IntroductionEsophageal rupture caused by blunt chest trauma is a very rare entity, with an incidence of 0.001%. Eighty two percent of the esophageal perforation secondary to blunt chest trauma occur above the level of the carina, with the lowest reported incidence in the intrathoracic region distal to the carina.Presentation of caseWe report on the case of a 48-year-old Hispanic male with intrathoracic esophageal rupture. Exploration revealed a right lateral, mid esophageal, longitudinal 1.5 cm perforation. The defect was repaired using a double-layered primary closure reinforced with an intercostal muscle flap. The patient tolerated the procedure and the recovery was complicated by a pneumonic process which was treated accordingly. No leakage was found.DiscussionA five-year retrospective review (2009–2013) at our institution identified 5586 trauma cases with only one case with esophageal rupture. This represents a 0.0002% of incidence of blunt esophageal rupture. This estimate is consistent with what has been previously reported in the medical literature. Our case represents a uniquely rare presentation of traumatic esophageal rupture due to the underline mechanism of injury and its anatomical location. A high index of suspicion and early intervention are critical in assuring a favorable outcome.ConclusionDiagnosis and surgical intervention with primary repair completed in the first twenty-four hours after presentation is fundamental to achieve a good outcome after esophageal rupture.

Esophageal Rupture Due to Diving in Shallow Waters

“…The incidence of blunt esophageal rupture has been reported to be 0.0002% of all blunt chest injuries [1]. There have been reports of esophageal rupture in the cervical area due to fall down [3], however, esophageal rupture after neck injury after diving at a site far from the injury site is unaccounted for.…”

“…Esophageal rupture caused distal to the carina and distal from the site of blunt injury due to barotrauma is an extremely rare event. Seventy percent of esophageal ruptures due to blunt injury are found late and have poor prognosis [1,2]. We report a rare case of distal esophageal rupture after blunt injury caused by barotrauma.…”

“…Esophageal rupture caused by blunt trauma has been reported to occur in 0.001% of all esophageal ruptures and they most commonly occur above the level of the carina [1]. Esophageal rupture caused distal to the carina and distal from the site of blunt injury due to barotrauma is an extremely rare event.…”

Oesophageal perforation – therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009–2015)

“…According to international the literature, if esophageal perforation is suspected, CT scan with an oral administration of water-soluble contrast agents should be performed as a supplementary examination. However, this examination may deliver false negative results (their percentage being as high as 36%); if a negative result is obtained in on the first examination, but and still viable premises exist for the suspicion of esophageal perforation is still suspected, the examination should be supplemented by an examination involving oral administration of a barium sulfate-based contrast agent should be administered [4,5,6]. upon palpation of soft tissues in the neck region (24%) [4,9].…”

Blunt Esophageal Injury and Importance of Early Diagnosis: A National Trauma Data Bank Analysis

“…1,2 The incidence of blunt esophageal trauma in the literature is reported as 0.001%. 1,3,4 The diagnosis is often difficult because patients have few specific symptoms on presentation. The clinical presentation varies based on location of the injury, size of perforation, degree of contamination, and presence of associated injury.…”