[Traumatic wounds of the esophagus]

Thirty four (75.5%) individuals sustained gunshot wounds, nine (20%) stab wounds, while two (4.4%) suffered blunt trauma. Thirty four patients (75%) displayed severance of the cervical portion of the esophagus, seven (15.5%) of the thoracic segment and only four (8.8%) had injuries on the abdominal portion. The cervical esophagus was surgically approached through oblique left side cervicotomy with primary suture and drainage with Penrose drain. A postero-lateral right side thoracotomy was employed for lesions of the upper and intermediate portion of the thoracic esophagus. When the lower portion of the esophagus was injured, a left side thoracotomy was employed. When the injury involved less than half of the perimeter of the esophagus suturing with ample drainage was adopted. In more extensive injuries involving over half of the perimeter total esophagectomy was the treatment of choice. In abdominal esophageal injuries laparotomy, suture and drainage were performed. Complications occurred in 40% of all patients. Seven patients died though only one from direct consequences of the esophageal injury. The authors believe that an early surgical approach for traumatic esophageal injuries is the best procedure. Primary suture and drainage score the best results. Other measures (esophagectomy, esophagostomy, gastrostomy) should be adopted only when the injury is either extensive or mediastinal contamination is present.