Oesophageal trauma: incidence, diagnosis, and management.

Triggiani, E; Belsey, Ronald

doi:10.1136/thx.32.3.241

Cited by 110 publications

(40 citation statements)

References 8 publications

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“…Delay increases morbidity and mortality and attempting repair in these patients is unlikely to succeed; 17 these patients should ideally undergo debridement and drainage without attempted repair. 2,7,9,17,21 Although some authors use double-layer repair, 1,8,22 other studies have shown that repair with a single layer is safe and effective both in traumatic 16,23 and non-traumatic situations. 24,25 Our policy is to use a single layer suture.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors advocate its use for all injuries greater than 16-h old and those with extensive tissue loss. 7,17,18 Others suggest its use only in instances where purulence is found to have already advanced into the mediastinum, where oesophageal violation extends below the level of the thoracic inlet, where there is prolonged direct contamination of the mediastinum as well as in patients with failed primary repair. 9,10,16 We share this latter view.…”

Section: Discussionmentioning

confidence: 99%

“…While some authors advocate mandatory exploration of all penetrating wounds to the cervical oesophagus, 2,16,[18][19][20] others favour a selective approach, exploring only those patients with symptoms, signs or investigative evidence of injury to the trachea and oesophagus. 6,9,10,17,21 Proponents of the mandatory approach argue that clinical and radiological assessment is unreliable and that major, potentially fatal, injuries may be missed. Those employing the selective policy cite the high incidence of negative exploration with its attendant morbidity if routine exploration is employed.…”

Section: Discussionmentioning

confidence: 99%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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Background: There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective. Patients and Methods: This is a retrospective study carried out over 5 years (1994)(1995)(1996)(1997)(1998). Of 1358 patients with neck trauma, 220 presented with odynophagia, of whom 28 were shown on contrast swallow to have cervical oesophageal injury (17 stabs, 11 firearms). Median age was 26 years (range, 11-44 years). There were 23 males (M:F ratio, 6:1). All patients with contained extravasation were managed non-operatively irrespective of the delay from injury to admission. Repair was undertaken in patients with major disruption and those requiring exploration for another reason. Associated tracheal injuries were repaired primarily with or without tracheostomy. Patients were fed using fine bore enteral feeding tubes. Oral feeding was recommenced after a water soluble contrast swallow had confirmed healing. Results: All patients presented with odynophagia. Seven had clinical surgical emphysema, and 15 had retropharyngeal air on lateral neck X-ray. Chest X-ray showed surgical emphysema in 8, haemothorax in 2 and pneumothorax in 2. Seventeen patients were managed non-operatively. Sixteen recovered with no complications, while one developed local sepsis. Eleven patients underwent exploration (debridement in 7 and primary repair in 4). There were 6 associated tracheal injuries, all of whom underwent primary repair with tracheostomy performed in four. Thirteen patients were admitted to the intensive care unit. Median duration of enteral tube feeding was 18 days (range, 5-40 days) and median hospital stay was 18 days (range, 6-91 days). Two patients with firearm injuries died from associated injuries. Conclusion: Non-operative management of penetrating injuries to the cervical oesophagus is safe and effective.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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“…Triggiani and Belsey (1977) reported 1 death out of 11 cases over 25 years. Five of these cases were diagnosed 24 h or more after perforation, yet 4 survived.…”

Section: Resultsmentioning

confidence: 95%

Rupture of the abdominal oesophagus: A review

Walsh¹

1979

British Journal of Surgery

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'Spontaneous' rupture of the oesophagus usually affects the lower third, less commonly the middle third and rarely the cervical oesophagus. Rupture limited to the intra-abdominal oesophagus is rare. Such a case is described here and previously reported cases are reviewed. Vomiting-induced gastro-oesophageal injuries and their aetiology are discussed and the management of spontaneous rupture is reviewed.

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“…In our series we had no complications, but ours was a small series of patients. In the literature available to us, the incidence of instrumental perforation was found to vary from 0.2% to 0.8%, depending on the type of endoscopic procedure used [6,37,40,45]. The risk of perforation with rigid or open-tube endoscopy is much greater than with flexible endoscopy.…”

Section: Value Of Direct Laryngoscopymentioning

confidence: 99%

Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer

Dhooge

Vos

Albers

et al. 1996

Eur Arch Otorhinolaryngol

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Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how they adversely affect the patient's survival, it becomes imperative to analyze how the clinician can intervene effectively. One such approach is to detect multiple primaries as early as possible. As such, panendoscopy as a part of the tumor-staging procedure has been advocated by many investigators to search for simultaneous second primary malignant neoplasms in patients presenting with head and neck cancer. In a 24-month period, data were gathered from 127 consecutive patients referred to University Hospital, Gheni with previously untreated, squamous cell carcinomas of the head and neck. One hundred-eighteen patients underwent an endoscopic examination under general anesthesia, during which 4 simultaneous second primary tumors were found in 3 patients. This represents an incidence of 3.4% of simultaneous second primary neoplasms. The results for the different parts of the endoscopy are discussed and compared with literature findings. Guidelines are given for the initial evaluation of the head and neck cancer patient.

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Oesophageal trauma: incidence, diagnosis, and management.

Cited by 110 publications

References 8 publications

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Rupture of the abdominal oesophagus: A review

Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer

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