Esophageal trauma

Injury from blunt or penetrating trauma to the esophagus is relatively rare. Treatment strategy is contingent on the clinical status of the patient, associated injuries, and the degree of esophageal injury and the time of injury until diagnosis. Although nonoperative intervention may be acceptable in highly selected patients with contained injuries or those who are more than 24 hours removed from the injury and are clinically stable, operative intervention is the most conservative and safest approach. There are many potential surgical approaches but resection or diversion should be discouraged. Operative approaches include either side of the neck or chest, and an abdominal approach for selected injuries. Sometimes combined incisions are needed. The goal of any operation for a traumatic esophageal injury is removal of infected material, debridement of the esophagus, assessment of the distal and proximal extent of the injury, decortication of the lung if the injury soils the pleural space, primary closure of the esophageal defect if possible with buttressing of the closure with autologous pedicles tissue or muscle flaps, and to ensure distal patency without esophageal pathology.