Blunt traumatic esophageal injury: Unusual presentation and approach

Abstract

INTRODUCTIONBlunt esophageal injury is extremely rare event. However, it is a potential morbid injury unless managed early.PRESENTATION OF CASEWe report a rare case of blunt esophageal injury for a 28-year old male who presented with history of fall of heavy object over the right side of the chest. Diagnostic work up including chest X-ray, computerized tomography scans and gastrografin esophagogram revealed lower esophageal rupture. Right mini-thoracotomy with esophageal repair was performed. Postoperative course was uneventful.DISCUSSIONThe exact mechanism of blunt esophageal injury remains uncertain. This report described a unique location of esophageal rupture after blunt trauma that happened on the right side. Diagnosis of esophageal injury needs high index of suspicion and accurate diagnostic workup.CONCLUSIONPrompt diagnosis and management are the key for better prognosis in patients with blunt esophageal injury.

External air compression: A rare cause of blunt esophageal injury, managed by a stent

“…Early diagnosis of esophageal rupture is of vital importance, and once the diagnosis is confirmed, esophageal perforation should be management on urgent basis by a team of experts. 3,6 The role of oral methylene blue in the differential diagnosis of esophageal injury was appreciated in our case. Early diagnosis of esophageal perforation (<12 h) requires direct surgical repair, although the data on use of stent in traumatic injuries are lacking.…”

“…Previously, we have reported a case of blunt trauma due to fall of heavy object that resulted in injury to the middle esophagus requiring surgical repair through the right thoracotomy. 6 The low incidence of esophageal injuries is attributed to its protection by hard shell of chest wall, flexibility and deep seated location in the posterior mediastinum. Experimental studies have investigated the pressure needed to cause esophageal rupture and showed that rupture of the esophagus may occur with an average pressure of 5 psi.…”

Acute mediastinitis after gastric rupture due to blunt trauma: A case report

“…Distal esophageal rupture with the spillage of upper gastrointestinal contents into the chest is most frequently encountered on the left side due to the anatomical position of the esophagus [ 4 ]. Therefore, the best approach to the distal esophagus would be VATS as an alternative to thoracotomy [ 4 ]. To the best of our knowledge, acute mediastinitis after gastric rupture due to blunt trauma has not been reported yet.…”

“…A previous report has described pericarditis that may have occurred due to concomitant ruptures in the stomach and central diaphragm [ 3 ]. In general, the mortality rate in cases of acute mediastinitis due to esophageal rupture is up to 20% [ 4 ]. However, acute mediastinitis after gastric rupture due to blunt trauma is very rare.…”

Late presentation of esophageal rupture following blunt thoracic trauma

“…2,3 The management and prognosis depend on the site and extent of injury, time of presentation, and degree of contamination. Although food particles in the intercostal drain raise a strong suspicion, esophageal rupture can be confirmed by computed tomography, 4 Gastrografin esophagogram, 5 or flexible esophagoscopy. 6 An aggressive management strategy with diversion and decontamination coupled with early institution of enteral feeding are essential.…”