Penetrating external injuries of the oesophagus and pharynx

Fifty-one instances of oesophageal perforation were discovered when the records of 10,143 [corrected] patients with external penetrating injuries of the neck, chest and abdomen were reviewed. Of these, 33 resulted from stab wounds, 17 from bullets and one from hyperextension of the neck. There were 15 perforations of the pharynx and 36 of the oesophagus. Oesophagography in a lateral decubitus position demonstrated the perforation in all 16 patients in whom it was used. In 45 patients simple repair within 24 h of injury was performed (mortality rate 11 per cent). In six patients with a delay of more than 24 h in the repair of the thoracic oesophagus, special techniques were preferred. In two patients an oesophageal diversion-exclusion method was used; one such patient died. In four patients repair over a large-bore T tube was carried out with one death. The main cause of mortality was associated spinal injury (four deaths).