Perforations of the Esophagus from Gunshot Wounds

Popovsky, Julio

doi:10.1097/00005373-198404000-00010

Cited by 28 publications

(14 citation statements)

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“…The disadvantage of this procedure is the requirement for recurrent operations in order to achieve continuity of the esophagus, and continued patient discomfort. Popovsky used double‐fold, absorbable dexon fiber for ligation of the distal esophagus 35 . In this approach, a secondary thoracotomy to undo the knot in the esophagus is not necessary.…”

Section: Discussionmentioning

confidence: 99%

Current management of esophageal perforation: 20 years experience

Eroğlu

Türkyılmaz

Aydın

et al. 2009

Diseases of the Esophagus

134

100

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Esophageal perforations are surgical emergencies associated with high morbidity and mortality rates. No single strategy has been sufficient to deal with the majority of situations. We aim to postulate a therapeutic algorithm for this complication based on 20 years of experience and also on data from published literature. We performed a retrospective clinical review of 44 patients treated for esophageal perforation at our hospital between January 1989 and May 2008. We reviewed the characteristics of these patients, including age, gender, accompanying diseases, etiology of perforation, diagnosis, location, time interval between perforation and diagnosis, treatment of the perforation, morbidity, hospital mortality, and duration of hospitalization. Perforation occurred in the cervical esophagus in 14 patients (31.8%), thoracic esophagus in 18 patients (40.9%), and abdominal esophagus in 12 patients (27.3%). Management of the esophageal perforation included primary closure in 23 patients (52.3%), resection in 7 patients (15.9%), and nonsurgical therapy in 14 patients (31.8%). In the surgically treated group, the mortality rate was 3 of 30 patients (10%), and 2 of 14 patients (14.3%) in the conservatively managed group. Four of the 14 nonsurgical patients were inserted with covered self-expandable stents. The specific treatment of an esophageal perforation should be selected according to each individual patient. To date, the most effective treatment would appear to be operative management. With improvements in endoscopic procedures, the morbidity and mortality rates of esophageal perforations are significantly decreased. We suggest that minimally invasive techniques for the repair of esophageal perforations will be very important in the future treatment of this condition.

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Section: Discussionmentioning

confidence: 99%

Current management of esophageal perforation: 20 years experience

Eroğlu

Türkyılmaz

Aydın

et al. 2009

Diseases of the Esophagus

134

100

View full text Add to dashboard Cite

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“…Both conservative and operative approaches are accompanied by a course of antibiotics, nothing-by-mouth and surgical nutrition. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Conservative management of non‐iatrogenic perforating injuries is much less common. Studies looking at management are almost exclusively surgical in nature 14,19,25,31–37 . The excluding factor tends to be a clinically obvious need for surgical exploration to determine the extent of injury and the need for repair of other structures within the neck.…”

Section: Managementmentioning

confidence: 99%

“…The overall mortality, considering data from more than 700 patients in several studies performed between 1990 and 2003 is 15–20% 7,8,14,19,25,31–39,61 . This incorporates all mechanisms of injury both iatrogenic and non‐iatrogenic.…”

Section: Managementmentioning

confidence: 99%

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A state-of-the-art review of esophageal trauma: where do we stand?

Plott

Gwynne‐Jones

McDermott

et al. 2007

Diseases of the Esophagus

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The esophagus provides a diagnostic and therapeutic pathway not only for gastroenterologists but for surgeons, radiologists, cardiologists, and other specialists. Unfortunately, this procedural traffic occasionally leads to iatrogenic injury. As well, though reasonably well protected anatomically, frank esophageal injuries due to non-iatrogenic causes are not uncommon. We present a review of the literature on this subject covering anatomy, etiology, diagnostics, therapeutics, and management generally.

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Perforations of the Esophagus from Gunshot Wounds

Cited by 28 publications

References 0 publications

Current management of esophageal perforation: 20 years experience

Current management of esophageal perforation: 20 years experience

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

A state-of-the-art review of esophageal trauma: where do we stand?

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