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Esophageal perforation following external blunt trauma
S L Beal1, E W Pottmeyer, J M Spisso
1Department of Surgery, University of California, Davis, Sacramento 95817.
The Journal of Trauma
|October 1, 1988
Summary
Esophageal perforation from blunt trauma is rare, often missed due to non-specific symptoms. Delayed diagnosis increases infectious complications and mortality risk.
Area of Science:
- Trauma Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal perforation from external blunt trauma is an exceedingly rare injury.
- This study reviews 96 reported cases since 1900, including five new cases.
Observation:
- Violent vehicular trauma is the most common cause.
- Perforation typically occurs in the cervical and upper thoracic esophagus (82%).
- Esophageal injury findings were present in 78% of cases, but diagnosis was delayed in two-thirds.
Findings:
- Diagnostic difficulty arises from a lack of specific symptoms, leading to misattribution to other injuries or incomplete workups.
- Infectious complications occurred in 38% of cases, with 21 linked to diagnostic delays.
- Sepsis from esophageal perforation resulted in five (9.4%) deaths.
Implications:
- Highlights the critical need for heightened clinical suspicion for esophageal perforation in blunt trauma.
- Emphasizes the importance of timely and accurate diagnosis to mitigate severe complications and improve patient outcomes.
- Suggests a review of diagnostic protocols for blunt chest trauma to include earlier esophageal injury assessment.