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Blunt Pharyngoesophageal Injuries: Current Management Strategies.

G Barmparas1, P H Navsaria2, D Serna-Gallegos1

  • 11 Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society
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PubMed
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Blunt pharyngoesophageal injuries can often be managed without surgery. Selective non-operative management is feasible and does not increase mortality for these rare trauma cases.

Keywords:
Pharyngeal injuriesblunt traumaneck traumanonoperative managementpharyngoesophageal injuries

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Area of Science:

  • Trauma Surgery
  • Surgical Management
  • Emergency Medicine

Background:

  • Blunt pharyngoesophageal injuries present a significant management challenge for trauma surgeons.
  • These injuries are rare, constituting a small fraction of trauma cases.

Purpose of the Study:

  • To investigate the feasibility and outcomes of expectant (non-operative) management for blunt pharyngoesophageal injuries.
  • To determine if neck exploration is always necessary for these injuries.

Main Methods:

  • Retrospective review of the National Trauma Databank (2007-2011).
  • Analysis of blunt trauma patients with pharyngeal and cervical esophageal injuries.
  • Comparison of outcomes (mortality, hospital stay) between patients who underwent neck exploration and those managed non-operatively, focusing on survivors over 24 hours not transferred from other institutions.

Main Results:

  • 545 patients with blunt pharyngoesophageal injuries were identified.
  • Of those eligible for comparison, 23% underwent neck exploration; these patients had a higher injury burden (ISS, ICU admission).
  • Overall mortality was 2%, with no significant difference between operative and non-operative groups (adjusted p=0.54). Patients undergoing neck exploration had longer hospital stays (adjusted p=0.03).

Conclusions:

  • Blunt pharyngoesophageal injuries are uncommon.
  • The decision for neck exploration is influenced by the severity of the injury.
  • Selective non-operative management is a viable option, showing no increased mortality and potentially shorter hospital stays.