[Mechanical penetrating esophageal injuries]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Trauma Surgery

Background:

• Penetrating esophageal injuries pose significant management challenges.
• A diverse range of etiologies, including instrumental lesions, foreign bodies, ruptures, and traumatic wounds, necessitate tailored treatment approaches.

Purpose of the Study:

• To present results of combined treatment for 850 patients with penetrating esophageal injuries.
• To detail diagnostic methods and develop indications for conservative and operative treatments.
• To describe management strategies for severe complications such as mediastinitis and esophageal fistulas.

Main Methods:

• Utilized a combination of roentgenologic, endoscopic, ultrasound, and immunologic examinations for diagnosis.
• Developed and applied specific indications for conservative and operative interventions.
• Employed surgical procedures including drainage, esophageal wall suturing, and distal esophagus exclusion.

Main Results:

• Surgical intervention was performed on 650 patients.
• Mortality rates varied by procedure: 33% for drainage, 11.8% for suturing, and 6.6% for distal esophagus exclusion.
• Active drainage methods proved effective in managing complications like mediastinitis and pleural empyema.

Conclusions:

• Combined diagnostic and therapeutic strategies are crucial for managing penetrating esophageal injuries.
• Surgical interventions, particularly drainage, can significantly improve outcomes.
• Effective management of complications like esophageal fistulas and bleeding is essential for reducing mortality.