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Transmediastinal gunshot injuries.

E Degiannis¹, C A Benn, E Leandros

¹Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, South Africa.

|July 6, 2000

Summary

For transmediastinal gunshot injuries, angiography for thoracic aorta assessment should precede esophageal evaluation. Prompt diagnosis and surgical intervention are critical for improving patient survival rates in these rare cases.

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Area of Science:

Trauma Surgery
Thoracic Surgery
Emergency Medicine

Background:

Transmediastinal gunshot injuries are rare and pose diagnostic challenges.
The optimal sequence for evaluating the thoracic aorta and esophagus after such injuries is debated.
Historically, aortic assessment preceded esophageal investigation.

Purpose of the Study:

To evaluate the diagnostic yield and outcomes of current investigation protocols for transmediastinal injuries.
To determine the optimal order of imaging for the thoracic aorta and esophagus.
To identify factors influencing patient survival after transmediastinal gunshot injuries.

Main Methods:

Retrospective analysis of 118 patients with potential transmediastinal injuries.
Unstable patients proceeded directly to the operating room.

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Stable patients underwent initial angiography for aortic injury, followed by esophageal investigation if indicated.

Main Results:

Of 51 urgent thoracotomy/sternotomy patients, 27 had mediastinal hemorrhage (17 died), and 8 had aortic injury (1 survivor).
In 57 stable patients, initial angiography identified only one aortic injury with a good outcome.
Subsequent esophageal investigation revealed injuries in 17 patients, all treated operatively with 15 satisfactory outcomes.

Conclusions:

Current evidence supports prioritizing angiography for thoracic aorta assessment before esophageal investigation.
Reducing the time from admission to operation is crucial for improving outcomes.
Prospective multi-center studies are needed to evaluate novel imaging modalities for expedited diagnosis.