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

Abstract

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.

Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it necessary?

“…However, this is in line with others who have noted an incidence of esophageal injury in post-traumatic patients in the range of 2-6 % [10][11][12][13]. In our study, we had 3 positive cases out of 49 patients with an incidence of 6%.…”

Esophagogastric Trauma in Scotland

“…Although the site of esophageal injury was not documented in this study, there is established evidence that a nonoperative strategy is safe and effective for the management of penetrating injuries to the cervical esophagus [4]. However, it is difficult to know in the current context, if the decision for nonoperative management was an active one or if the esophageal injury was simply not detected until later.…”

Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

“…[24][25][26][27][28] This has become the international standard in centers handling a high trauma load. 21,[28][29][30][31][32][33][34] Given the average delay between injury and hospitalization in our patients and the large number of those sustaining penetrating trauma, the absence of clinical signs is a reliable means of excluding intraabdominal injury.…”