Tracheoesophageal Injury Following Gunshot Wound to the Chest: A Case Report

Thoracic tracheal injuries resulting from gunshot wounds are extremely rare traumatic events associated with high mortality rates, necessitating immediate airway and surgical intervention. We present the case of a 46-year-old man with a gunshot wound to the chest that resulted in an 80% thoracic tracheal laceration coupled with an associated esophageal perforation. The patient presented with severe dyspnea, extensive emphysema, and ineffective ventilatory mechanics despite initial management. Emergency surgical management involved a median sternotomy for tracheal exposure and repair. However, due to an intraoperative cardiac arrest, an emergent left anterior thoracotomy was required for direct cardiac massage and subsequent esophageal management. A primary terminal-to-terminal tracheoplasty was performed, and the esophageal injury was repaired using an intercostal muscle patch. The patient was extubated uneventfully on postoperative Day 3 and was discharged 10 days later. This case highlights the need for rapid and decisive action in complex tracheal injuries. The combined dual surgical approach (sternotomy and emergency thoracotomy) proved to be a viable and potentially life-saving strategy in the context of critical penetrating chest trauma.