Blunt traumatic rupture of the thoracic oesophagus.

Abstract

A man with a crush injury of his upper abdomen developed bilateral pulmonary empyema after repair of tears of the oesophagus and liver. Attempts to withdraw chest drains led to recurrent septicaemia, treated by reinsertion of the drains plus administration of antibiotics. The communication of the empyema space with both the bronchial tree and the oesophagus was managed successfully with intermittent positive pressure ventilation and with a double lumen endobronchial tube isolating the right lung for 10 days. Traumatic rupture of the thoracic oesophagus carries a high mortality and prompt repair is vital.Reports of oesophageal rupture following blunt thoracic or abdominal trauma are rare. The first, in 1936,' described the unsuccessful result in a case of blunt traumatic rupture of the lower third ofthe thoracic oesophagus. A review ofpublished reports of this unusual and therefore unsuspected injury follows the presentation of our case. Case reportA 19 year old labourer was transferred to St Bartholomew's Hospital, having sustained a crush injury of his upper abdomen after being pinned to a wall by a dumper truck for seven minutes. His presenting complaint was of lower chest and upper abdominal pain, and on examination he had bruising over this region. His blood pressure was 90/ 60 mm Hg and pulse rate 145 beats/minute, and he was afebrile. The chest radiograph confirmed the clinical signs of a left pleural effusion and showed no evidence of traumatic gastric herniation. A left sided intrathoracic chest drain was inserted and partially digested food was drained.The patient was taken to the operating theatre with a presumptive diagnosis of a ruptured oesophagus. Through a left thoracolaparotomy the left pleural cavity, soiled by gastric contents, was washed out. The mediastinal pleura and disrupted lower third of the oesophagus could then be seen. The oesophageal tear was primarily repaired with two layers of prolene sutures. Bleeding was noted from below the diaphragm. This was from a linear tear in the diaphragmatic surface of the right lobe of the liver, and was repaired by direct suture via a right thoracotomy. The right chest cavity was also soiled, and was therefore cleaned and drained. His Address for reprint requests: Mr S

Infectious spondylodiscitis caused by esophageal injury after blunt chest trauma

“…[2][3][4] In the current patient, the initial radiographs showed no paraesophageal manifestations of rupture such as mediastinal collections, abscess, or effusion. Although the patient did not initially report symptoms, esophageal tears may develop after a traffic accident.…”

Blunt traumatic esophageal injury: Unusual presentation and approach

“…However, it has been speculated that instant dilatation of the esophagus could be possible due to pressurized air which pushes the cricopharyngeal sphincter. This high pressure might lead to esophageal rupture, if the esophagogastric sphincter remains closed 15 . Many factors contribute to the rarity of esophageal injury including the protective location of the esophagus deep in the posterior mediastinum, easy mobility (lack of tethering), the rigid hard shell of human chest 16 .…”

“…This high pressure might lead to esophageal rupture, if the esophagogastric sphincter remains closed. 15 Many factors contribute to the rarity of esophageal injury including the protective location of the esophagus deep in the posterior mediastinum, easy mobility (lack of tethering), the rigid hard shell of human chest. 16 Blunt esophageal injuries are caused by an unusual increase in pressure of the esophageal lumen due to a strong blow to the epigastrium.…”

Traumatismes Fermés Du Thorax

“…Il s'agit soit d'une déchirure longitudinale, soit d'une origine ischémique secondaire à des lésions des vaisseaux oesophagiens par traction-dilacération ou encore d'une augmentation de la pression intraluminale oesophagienne par compression abdominale à glotte fermée [91]. Le pronostic est catastrophique en cas de diagnostic ignoré ou retardé.…”