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Papaconstantinou D, Kapetanakis EI, Mylonakis A, Davakis S, Kotidis E, Tagkalos E, Rouvelas I, Schizas D. Current aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis. Dis Esophagus 2024; 37:doae007. [PMID: 38366609 DOI: 10.1093/dote/doae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
Trauma-related esophageal injuries (TEIs) are a rare but highly lethal condition. The presentation of TEIs is very diverse depending on the location and mechanism of injury (blunt vs. penetrating), as well as the presence or absence of concurrent injuries. The aim of the present systematic review and meta-analysis is to delineate the clinical features impacting TEI management. A systematic review of the Medline, Embase, and web of science databases was undertaken for studies reporting on patients with TEIs. A random effects model was employed in the meta-analysis of aggregated data. Eleven studies, incorporating 4605 patients, were included, with a pooled mortality rate of 19% (95% confidence interval (CI) 13-25%). Penetrating injuries were 34% more likely to occur (RR 0.66, 95% CI 0.49-0.89, P = 0.01), predominantly in the neck compartment. Surgery was employed in 53% of cases (95% CI 32-73%), with 68% of patients having associated injuries (95% CI 43-94%). In terms of choice of surgical repair technique, primary suture repair was most frequently reported, irrespective of injury location. Postoperative drainage was employed in 27% of the cases and was more common following repair of thoracic esophageal injuries. The estimated dependence on mechanical ventilation was 5.91 days (95% CI 5.1-6.72 days), while the length of stay in the intensive care unit averaged 7.89 days (95% CI 7.14-8.65 days). TEIs are uncommon injuries in trauma patients, associated with considerable mortality and morbidity. Open suture repair of ensuing esophageal defects is by large the most employed approach, while stenting may be indicated in carefully selected cases.
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Affiliation(s)
- Dimitrios Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Adam Mylonakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Spyridon Davakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Efstathios Kotidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Evangelos Tagkalos
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ioannis Rouvelas
- Center for Digestive Diseases, Karolinska University Hospital and the Division of Surgery and Oncology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Walker PF, Galvagno SM, Sachdeva A, Feliciano DV, Scalea TM, O'Connor JV. Operative Management of Aerodigestive Injuries: Improved Survival Over two Decades. Am Surg 2023; 89:5982-5987. [PMID: 37283249 DOI: 10.1177/00031348231180917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Non-iatrogenic aerodigestive injuries are infrequent but potentially fatal. We hypothesize that advances in management and adoption of innovative therapies resulted in improved survival. METHODS Trauma registry review at a university Level 1 center from 2000 to 2020 that identified adults with aerodigestive injuries requiring operative or endoluminal intervention. Demographics, injuries, operations, and outcomes were abstracted. Univariate analysis was performed, P < .05 was statistically significant. RESULTS 95 patients had 105 injuries: 68 tracheal and 37 esophageal (including 10 combined). Mean age 30.9 (± 14), 87.4% male, 82.1% penetrating, and 28.4% with vascular injuries. Median ISS, chest AIS, admission BP, Shock Index, and lactate were 26 (16-34), 4 (3-4), 132 (113-149) mmHg, .8 (.7-1.1), and 3.1 (2.4-5.6) mmol/L, respectively. There were 46 cervical and 22 thoracic airway injuries; 5 patients in extremis required preoperative ECMO. 66 airway injuries were surgically repaired and 2 definitively managed with endobronchial stents. There were 24 cervical, 11 thoracic, 2 abdominal esophageal injuries-all repaired surgically. Combined tracheoesophageal injuries were individually managed and buttressed. 4 airway complications were successfully managed, and 11 esophageal complications managed conservatively, stented, or resected. Mortality was 9.6%, half from intraoperative hemorrhage. Specific mortality: tracheobronchial 8.8%, esophageal 10.8%, and combined 20%. Mortality was significantly associated with higher ISS (P = .01), vascular injury (P = .007), blunt mechanism (P = .01), bronchial injury (P = .01), and years 2000-2010 (P = .03), but not combined tracheobronchial injury. CONCLUSION Mortality is associated with several variables, including vascular trauma and years 2000-2010. The use of ECMO and endoluminal stents in highly selected patients and institutional experience may account for 97.8% survival over the past decade.
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Affiliation(s)
| | - Samuel M Galvagno
- RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | | | - David V Feliciano
- RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Thomas M Scalea
- RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - James V O'Connor
- RA Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
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Xu AA, Breeze JL, Paulus JK, Bugaev N. Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank. Am Surg 2019. [DOI: 10.1177/000313481908500422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.
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Affiliation(s)
| | - Janis L. Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Jessica K. Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts; and
| | - Nikolay Bugaev
- Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Selective nonoperative management of pharyngoesophageal injuries secondary to penetrating neck trauma: A single-center review of 86 cases. J Trauma Acute Care Surg 2018; 85:541-548. [PMID: 29787546 DOI: 10.1097/ta.0000000000001973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This article describes our experience with penetrating pharyngoesophageal injuries (PEI) in the light of a selective conservative approach, and has the objective to define criteria for nonoperative management (NOM). METHODS This retrospective single-center review of patients with penetrating neck injury treated for confirmed PEI over a 6-year period aimed to test our proposed hypothesis that NOM is safe for hemodynamically stable patients with PEI, who have no competing indications for exploration, have no established sepsis, and who have a water-soluble contrast swallow either showing no- or a contained extravasation. RESULTS Eighty-six (9%) patients with PEI (oropharynx, 17; hypopharynx, 40; esophagus, 29) of 948 patients with penetrating neck injury were included. Of the cohort 38 (44%) underwent NOM (oropharynx, 15 [88%]; hypopharynx, 18 [45%]; esophagus, 5 [17%]), and 48 (56%) were managed operatively. The median length of stay was 12 days (interquartile range, 19-8). Fifteen (17%) had a persistent leak and six (7%) mediastinitis. Five (6%) patients died but only one (1%) had isolated PEI. Retrospectively, 27 patients fulfilled our proposed criteria for NOM of which 23 had been treated actively by NOM (oropharynx, 8; hypopharynx, 12; esophagus, 3). For these patients, the length of stay was 10.0 days (interquartile range, 13-6), and none developed deep wound sepsis, mediastinitis, persistent leaks, or died. Of the remaining patients treated by NOM without fulfilling the proposed criteria, two were palliated (esophagus) and 13 were managed actively (oropharynx, 7; hypopharynx, 6). Only four of these patients (oropharynx, 1; hypopharynx, 3) were assessed with water-soluble contrast swallow, which showed noncontained extravasation, and three complicated with persistent leaks. CONCLUSION Nonoperative management of PEI is safe for a carefully selected subgroup of patients. However, most injuries to the caudal part of the cervical digestive tract mandate urgent exploration. LEVEL OF EVIDENCE Clinical Management Study, Level V evidence.
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Omura T, Asieri M, Bischof K, Rambarran S, Moeng MS. Primary repair of a delayed presentation thoracic oesophageal gunshot injury: A report of two cases. Trauma Case Rep 2018; 12:45-47. [PMID: 29644284 PMCID: PMC5887087 DOI: 10.1016/j.tcr.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/28/2022] Open
Abstract
Thoracic oesophageal gunshot injuries are uncommon, and the morbidity and mortality rates are extremely high and depend on the elapsed time, injury severity, and concomitant organ damage. Thus, early diagnosis is paramount to avoid delays, which in turn confer poorer outcomes. Current management strategies are still controversial and depend on the patient's physiologic state. We experienced two cases of thoracic oesophageal gunshot injury, both of whom were treated by primary repair and were successfully discharged. Decision-making strategies should be based on the patient's physiologic reserve, experience of the attending surgical team, and ancillary services available at the facility.
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Affiliation(s)
- Takeshi Omura
- Surgery Department, Tokushima Prefectural Central Hospital, Kuramotocho, 1-10-3, Tokushima-city, Tokushima, Japan.,Trauma Unit, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, Gauteng, South Africa
| | - Mohammed Asieri
- Trauma Unit, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, Gauteng, South Africa
| | - Kirsten Bischof
- Trauma Unit, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, Gauteng, South Africa
| | - Sharan Rambarran
- Trauma Unit, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, Gauteng, South Africa
| | - Maeyane Stephens Moeng
- Trauma Unit, Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, 17 Jubilee Road, Parktown, Johannesburg, Gauteng, South Africa
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Madsen AS, Oosthuizen G, Laing GL, Bruce JL, Clarke DL. The role of computed tomography angiography in the detection of aerodigestive tract injury following penetrating neck injury. J Surg Res 2016; 205:490-498. [DOI: 10.1016/j.jss.2016.06.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/11/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
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Madsen AS, Laing GL, Bruce JL, Oosthuizen GV, Clarke DL. An audit of penetrating neck injuries in a South African trauma service. Injury 2016; 47:64-9. [PMID: 26264880 DOI: 10.1016/j.injury.2015.07.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/14/2015] [Accepted: 07/18/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study reviews and validates the practice of selective non-operative management (SNOM) of penetrating neck injury (PNI) in a South African trauma service and reviews the impact new imaging modalities have had on the management of this injury. METHODOLOGY This study was performed within the Pietermaritzburg Metropolitan Trauma Service, in the city of Pietermaritzburg, Kwazulu-Natal, South Africa. A prospectively maintained trauma registry was retrospectively interrogated. All patients with PNI treated over a 46-month period were included within the study. RESULTS A total of 510 patients were included in the study. There were 452 stab wounds (SW) and 58 gunshot wounds (GSW). A total of 202 (40%) patients sustained isolated PNI, the remaining 308 (60%) patients sustained trauma to at least one additional anatomical region. An airway injury was identified in 29 (6%) patients; a pharyngo-oesophageal injury in 41 (8%) patients and a vascular injury in 86 (17%) patients. Associated injuries included three penetrating cardiac injuries (PCI) and 146 patients with haemo-pneumothoraces. Of the total cohort, 387 patients (76%) underwent CT Angiography (CTA), of which 70 (18%) demonstrated a vascular injury. Formal catheter directed angiogram (CDA) was performed on 16 patients with positive CTA but confirmed injury in only half of these patients. Of 212 patients (42%) who underwent water-soluble contrast swallow (WS-swallow), an injury was demonstrated in 29 (14%) cases. A total of 401 (79%) patients were successfully managed conservatively for PNI and 109 (21%) surgically or by endovascular intervention. Only five (1.2%) patients failed a trial of SNOM and required surgery. The in-hospital mortality rate was 2%. No deaths could be attributed to a failure of SNOM. CONCLUSION SNOM of PNI is a safe and appropriate management strategy. The conservative management of isolated pharyngeal injuries is well supported by our findings but the role of conservative treatment of oesophageal injuries needs to be further defined. The SNOM of small non-destructive upper airway injuries seems to be a safe strategy, while destructive airway injuries require formal repair. Imaging merely for proximity, is associated with a low yield. CTA has a significant false positive rate and good clinical assessment remains the cornerstone of management.
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Affiliation(s)
- A S Madsen
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - J L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - G V Oosthuizen
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Pietermaritzburg, South Africa.
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Yeh DD, Hwabejire JO, de Moya M, King DR, Fagenholz P, Kaafarani HM, Klein EN. Preoperative evaluation of penetrating esophageal trauma in the current era: An analysis of the National Trauma Data Bank. J Emerg Trauma Shock 2015; 8:30-3. [PMID: 25709250 PMCID: PMC4335154 DOI: 10.4103/0974-2700.150394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/30/2014] [Indexed: 11/07/2022] Open
Abstract
Background: Preoperative diagnostic evaluation (PDE) of penetrating esophageal injury (PeEsIn) can delay treatment and increase morbidity. We sought to study the relationship among PDE, delay in definitive treatment, and patient mortality in PeEsIn. Materials and Methods: The 2008-2010 National Trauma Data Banks were queried for PeEsIn. Exclusion criteria were death within 1 day of injury, and missing data about survival to discharge or operative intervention. Data extracted included demographics, vital signs, injury severity, diagnostic procedures (endoscopy, computed tomography, and fluoroscopy), time to procedures and/or operation, hospital-free days, and mortality. Results: Of 280 patients, 75 underwent PDE and 205 did not. There were no significant differences in baseline demographics, vital signs or injury severity between the two groups. The median time to the first operation was shorter in the nonPDE cohort compared to the PDE cohort (2 vs. 3 h; P = 0.018). Median hospital-free days at day 60 were significantly less in nonPDE (42 days, interquartile range ([IQR] = [28, 50]) versus PDE patients (47 days, IQR = [38, 51]) (P = 0.007). Mortality was not statistically different. Conclusions: PDE in PeEsIn slightly delays the time to operation without worsening mortality, and is a predictor of more hospital-free days.
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Affiliation(s)
- Daniel Dante Yeh
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA
| | | | - Marc de Moya
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA
| | - David R King
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA
| | - Peter Fagenholz
- Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care; Harvard Medical School, Boston, MA, USA
| | | | - Eric N Klein
- Department of Surgery, Hartford Hospital, Hartford, Connecticut, USA
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Skipworth RJE, McBride OMB, Kerssens JJ, Paterson-Brown S. Esophagogastric Trauma in Scotland. World J Surg 2012; 36:1779-84. [DOI: 10.1007/s00268-012-1602-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Garcia-Toca M, Hayman A, Naughton P, Blum MG, Eskandari MK. Zone I Gunshot Neck Injury Treated with Common Carotid and Esophageal Stent Grafts. J Vasc Interv Radiol 2010; 21:1448-51. [DOI: 10.1016/j.jvir.2010.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 04/08/2010] [Accepted: 05/10/2010] [Indexed: 12/24/2022] Open
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Thoma M, Navsaria PH, Edu S, Nicol AJ. Analysis of 203 Patients with Penetrating Neck Injuries. World J Surg 2008; 32:2716-23. [DOI: 10.1007/s00268-008-9766-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Bazerbashi S, Villaquiran J, Bennett M, Unsworth-White MJ, Rahamim J. Stented esophageal transfixion injury. Ann Thorac Surg 2008; 86:1367-9. [PMID: 18805201 DOI: 10.1016/j.athoracsur.2008.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 03/05/2008] [Accepted: 03/19/2008] [Indexed: 10/21/2022]
Abstract
Esophageal perforation is a rare, but life-threatening condition with a mortality rate ranging between 10% and 40%. It can happen at the level of the cervical, intrathoracic, or intra-abdominal segment. It usually occurs as a result of iatrogenic injury after endoscopic procedures or as a spontaneous rupture. It is seen less frequently in trauma after gunshot or stab wounds. Stenting of the esophagus after iatrogenic perforation is well documented in the literature, but yet it is to be published for management of penetrating injury. We report a case of esophageal perforation with a wooden fence post treated successfully with a covered esophageal stent.
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Affiliation(s)
- Samer Bazerbashi
- South West Cardiothoracic Centre, Derriford Hospital, Plymouth, United Kingdom.
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14
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Breigeiron R, de Souza HP, Sidou JPP. Risk factors for surgical site infection after surgery for esophageal perforation. Dis Esophagus 2008; 21:266-71. [PMID: 18430110 DOI: 10.1111/j.1442-2050.2007.00779.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal perforations carry a high potential for morbidity and mortality. The prognosis depends on rapid and precise diagnosis and management. Surgical site infections (SSIs) are very common following the surgical treatment of esophageal lesions. We aimed identify significant risk factors for SSI after surgery for esophageal perforation via an historical cohort study including patients who underwent surgical management of esophageal perforation. The predictive variables were analyzed by bivariate analysis and multiple logistic regression. Eighty-one patients were studied during a 10-year period ending in 2004. The mean age was 42.6 years. In 44% of the patients the time interval between the perforation and surgery was up to 6 h and in 30% it was > 24 h. Associated lesions occurred in other cavities; 17% in the chest, 5% in the abdomen, 5% in the extremities, 4% in the spinal column and bone marrow and 2% in the face. There were grade I lesions in eight cases (10%), grade II in 64 cases (79%) and grade III in nine cases (11%). The mean time of surgery procedure was 117.2 min. The mean SSI was 7.99. SSIs occurred in 33 patients (41%). The risk factors for SSI following surgical management of esophageal perforation were: age > or = 50 years, time delay to treatment > 24 h, associated lesion in another cavity and Injury Severity Score > or = 15.
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Affiliation(s)
- R Breigeiron
- General Surgery Service and Digestive Surgery, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, and General and Trauma Surgery, Pronto Socorro de Porto Alegre, Porto Alegre, Brazil.
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15
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Abstract
A case of perforating injury to the hypopharynx following uneventful intubation is reported. As symptoms are relatively unspecific, perforating trauma of the pharynx, larynx, esophagus or trachea may temporarily remain undetected. Consecutive development of an abscess or mediastinitis can cause a potential vital threat to the patient. Depending on the defect size and the overall situation a conservative or surgical management should be followed. Persistent complaints of neck or thorax pain after endotracheal intubation should always raise suspicion of injury to the upper aerodigestive tract, even after uncomplicated intubation.
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Abstract
The esophagus provides a diagnostic and therapeutic pathway not only for gastroenterologists but for surgeons, radiologists, cardiologists, and other specialists. Unfortunately, this procedural traffic occasionally leads to iatrogenic injury. As well, though reasonably well protected anatomically, frank esophageal injuries due to non-iatrogenic causes are not uncommon. We present a review of the literature on this subject covering anatomy, etiology, diagnostics, therapeutics, and management generally.
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Affiliation(s)
- E Plott
- San Antonio Uniformed Services Health Education Consortium, Gastroenterology, TX, USA
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17
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Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for life-threatening hemorrhage in penetrating neck trauma. World J Surg 2006; 30:1265-8. [PMID: 16830215 DOI: 10.1007/s00268-005-0538-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Foley catheter (FC) balloon tamponade is a well-recognized technique employed to arrest hemorrhage from penetrating wounds. The aim of this study was to review our experience with this technique in penetrating neck wounds and to propose a management algorithm for patients with successful FC tamponade. METHODS A retrospective chart review (July 2004-June 2005 inclusive) was performed of patients identified from a prospectively collected penetrating neck injury computer database in whom FC balloon tamponade was used. The units' policy for penetrating neck injuries is one of selective nonoperative management. All patients with successful FC tamponade underwent angiography. A venous injury was diagnosed if angiography was normal. Ancillary tests were performed as indicated. Removal of the FC was performed in the OR. RESULTS During the study period, 220 patients with penetrating neck injuries were admitted to our unit. Foley catheter balloon tamponade was used in 18 patients and was successful in 17 patients. Angiography was positive in 3 patients, all of whom underwent surgery. The FC was successfully removed in 13 patients at a mean of 72 (range 48-96) hours. One patient bled after removal of the catheter, mandating emergency surgery. CONCLUSION Foley catheter balloon tamponade remains a useful adjunct in the management of selective patients with penetrating, bleeding neck wounds.
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Affiliation(s)
- Pradeep Navsaria
- Trauma Unit, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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18
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Weigelt JA. Penetrating injuries to the aerodigestive tract. SURGICAL PRACTICE 2005. [DOI: 10.1111/j.1744-1633.2005.00277.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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