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Retrograde esophageal intubation.

James V O'Connor1, Thomas M Scalea

  • 1R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.

The American Surgeon
|March 23, 2007
PubMed
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Retrograde esophageal intubation offers a novel solution for managing esophageal injuries in patients with prior gastrectomy and colectomy. This technique preserves esophageal length and controls secretions, aiding in damage control surgery.

Area of Science:

  • Surgical Innovation
  • Gastrointestinal Surgery
  • Trauma Management

Background:

  • Conventional esophageal injury treatment can be challenging in patients with prior gastrectomy and colectomy.
  • Preserving esophageal length is critical for reconstruction in these complex cases.
  • Existing methods may not adequately address drainage and diversion needs in such scenarios.

Observation:

  • A novel technique, retrograde esophageal intubation, was developed for patients requiring total gastrectomy and colon resection.
  • This method involves retrograde placement of an Ewald tube to create a controlled esophagocutaneous fistula.
  • The technique was successfully applied in three patients with penetrating trauma or failed gastric bypass.

Findings:

  • Retrograde esophageal intubation allows for long-term control of esophageal secretions without cervical esophagostomy.

Related Experiment Videos

  • The technique effectively preserves esophageal length, crucial for subsequent reconstruction.
  • Reconstruction, performed six months post-injury, utilized various techniques including esophagogastrostomy and Roux-en-Y esophojejunostomy, with manageable anastomotic leaks.

    • Implications:

    • Retrograde esophageal intubation is a simple, viable option for damage control surgery in complex esophageal injuries.
    • It provides a method for managing esophageal secretions and preserving length for future reconstruction.
    • This technique expands surgical options for patients with extensive prior abdominal surgeries and esophageal trauma.