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Noniatrogenic esophageal trauma

D S Weiman¹, W A Walker, K M Brosnan

¹Department of Surgery, University of Tennessee College of Medicine, Memphis 38163-2116.

The Annals of Thoracic Surgery

|April 1, 1995

Summary

Esophageal perforations from trauma can be safely repaired with minimal mortality. Early diagnosis and management of esophageal injuries are crucial for positive patient outcomes.

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Area of Science:

Trauma Surgery
Gastroenterology
Surgical Innovation

Background:

Limited guidelines exist for managing noniatrogenic esophageal injuries.
Early diagnosis and prompt management are critical for favorable outcomes in esophageal trauma.
This study reviews a 5-year experience with esophageal perforations at an urban trauma center.

Observation:

Nineteen patients with esophageal perforations (18 penetrating, 1 blunt) were identified between July 1988 and June 1993.
Eleven cervical esophageal injuries were surgically repaired; one was treated non-operatively.
Seven thoracic and abdominal esophageal perforations, all from gunshot wounds, were also managed.

Findings:

No mortality was observed in the study group; morbidity was primarily associated with concurrent injuries.
Cervical esophageal injuries did not routinely require drainage when identified and managed early.
Surgical repairs, sometimes reinforced with fundal wraps, were confirmed intact postoperatively via contrast studies.

Implications:

Penetrating and blunt esophageal tears are safely repairable with low mortality.
Associated injuries, such as spinal cord or tracheal damage, are the main contributors to morbidity.
Routine drainage of cervical esophageal injuries may not be necessary if diagnosed and treated promptly.

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