Esophagectomy for a traumatic esophageal perforation with delayed diagnosis

Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.