Penetrating external injuries of the oesophagus and pharynx

Hatzitheofilou, C; Strahlendorf, Caron; Kakoyiannis, S; Charalambides, D.; Δημητριάδης, Δημήτριος

doi:10.1002/bjs.1800800927

Cited by 33 publications

(24 citation statements)

References 10 publications

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“…3,6,12,18 The mortality rate in the present series was 7% and both patients died as a result of associated injuries due to firearm wounds rather than from the oesophageal injury per se. This demonstrated that firearm injuries are more devastating than stab injuries.…”

Section: Discussionmentioning

confidence: 54%

“…12 It confirms the site of injury, identifies the extravasation from the oesophagus, documents the size of the leak, and demonstrates if it is contained or not. The most commonly used modalities are contrast oesophagography and flexible oesophagoscopy.…”

Section: Discussionmentioning

confidence: 89%

“…16 A T-tube splinting method has been used by some authors for spontaneous oesophageal ruptures. 26 Hatzitheofilou et al 12 employed this method in four patients with delayed presentation of traumatic cervical oesophageal injury, one of whom died. This method has not received wide acceptance in the literature and it needs further evaluation.…”

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: 54%

Section: Discussionmentioning

confidence: 89%

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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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“…Nach Erfahrung von Hatzetheofilou und Ulrich ist eine primä r konservative Therapie ebenfalls bei kleinen iatrogenen Perforationen durch flexible Instrumente mö glich. Hier kann bei innerer Drainage unter absoluter Nahrungskarenz und antibiotischer Abschirmung eine Heilung zu erzielen sein [9,26]. Als Voraussetzungen fü r eine konservative Therapie gelten nach Junginger und Schulz eine umschriebene, gedeckte Perforation ohne Kommunikation mit einer Kö rperhö hle, die frü hzeitige Diagnosestellung sowie das Fehlen septischer Reaktionen [12,24].…”

Section: Therapieunclassified

“…Diese plastische Dekkung kann vor allem bei grö ßeren Defekten, bei bereits bestehenden entzü ndlichen Verä nderungen der Perforationsrä nder und bei fortgeschrittener Umgebungsreaktion empfehlenswert sein. Die ebenfalls empfohlene plastische Deckung durch Aufsteppen von gestielten Pleura-und Perikardlappen, von Zwerchfellanteilen oder des Magenfundus kann problematisch sein, da aufgrund der fortgeschrittenen Mediastinitis ein Mangel an intaktem Umgebungsgewebe bestehen dü rfte [9,19].…”

Section: Therapieunclassified

Die chirurgische Therapie der Oesophagusperforation Eine Standortbestimmung anhand von 4 eigenen Fällen und der Literatur

Mai

Nagel

Saeger

1997

Chirurg

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We present four cases of esophageal rupture (three iatrogenic, one Boerhaave syndrome) to demonstrate the difficulty in diagnosis and therapy. The current literature is discussed and conclusions are drawn as regards the modus operandi. All our patients were operated on. The site of esophageal rupture was always closed with a primary suture and substantial irrigation and drainage were performed. In two cases the suture line was in addition covered with fibrin glue or by an omentum flap, respectively. All patients survived and recovered was unremarkable. Our own results and a subsequent analysis of literature allow the following conclusions. At an early stage of esophageal rupture surgical intervention is indicated. The method of choice is primary closure of the rupture site by suture, possibly combined with a muscle or omentum flap. In cases of delayed diagnosis with advanced mediastinitis, suture of the rupture site should also be striven for. Additional coverage is advisable in these cases. Resection procedures with or without reconstruction should be done only in exceptional cases before of the high surgical risk.

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Image of the Month—Diagnosis

2013

JAMA Surg

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T he CT scan was very concerning for esophageal injury. To further delineate the operative approach of right thoracotomy vs left neck exploration to examine the esophagus, a meglumine diatrizote (Gastrografin) swallow study was performed. The swallow study showed a bullet in the superior mediastinum in the cervicothoracic esophagus. This was best approached through the left neck (Figure 2). At exploration, a 4-cm tear in the cervical esophagus was noted. The cervical esophagus injury was closed in 2 layers, with closure of the mucosa with an interrupted inner layer of 4-0 nonabsorbable suture. The muscular layer of the esophagus was closed with interrupted Lembert sutures of 4-0 silk. A Jackson-Pratt drain was placed. Postoperatively, the patient did well; he did develop a thoracic duct leak that was conservatively managed. He had negative Gastrografin swallow study results on postoperative day 6, tolerated a general diet, and was subsequently discharged home on postoperative day 13. Transmediastinal gunshot wounds can be devastating injuries. In hemodynamically unstable patients, immediate operation is indicated as these patients may have major cardiac or vascular injury. In hemodynamically stable patients, however, the patient can be uninjured or have occult vascular, esophageal, or tracheobronchial injury. Evaluation of these patients traditionally includes angiography, bronchoscopy, esophagoscopy, and pericardial window. With the advent of contrast-enhanced CT scan, however, evaluation of injury can often be accomplished with only a CT scan showing the missile tract through the mediastinum. Certainly further investigational studies can be used to better delineate injuries that may require further intervention. 1 Penetrating esophageal injuries are an uncommon injury because of the esophagus's central and protected lo

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Penetrating external injuries of the oesophagus and pharynx

Cited by 33 publications

References 10 publications

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

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

Die chirurgische Therapie der Oesophagusperforation Eine Standortbestimmung anhand von 4 eigenen Fällen und der Literatur

Image of the Month—Diagnosis

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