Esophageal perforation associated with fracture of the upper thoracic spine from blunt trauma: a case report

Abstract

We report the successful conservative management of an unusual case of esophageal perforation associated with an upper thoracic spinal fracture from blunt trauma in Minamata, Kumamoto, Japan. A 69-year-old man became paraplegic secondary to an L1 burst fracture caused by a boating accident and underwent posterior fixation on the day of admission. The patient also had a minimally displaced T4 vertebral fracture. Fever, dyspnea and elevated inflammatory markers all persisted postoperatively. Computed tomography showed free mediastinal air at the T4 level, and an esophagram showed contrast medium leakage, which helped diagnose esophageal perforation. The esophageal perforation healed with conservative treatment without life-threatening complications. The possibility of esophageal injury should always be considered when treating upper thoracic spinal injuries due to blunt trauma.

Esophageal Perforation and Epidural Abscess in a Patient with Thoracic Vertebral Fracture: A Case Report and Literature Review

“…In our literature review, only nine previously reported cases of esophageal perforation associated with thoracic vertebral fractures have been published. Thus, esophageal perforation seems to be a very infrequent complication of thoracic vertebral fractures (Table 1) [2][3][4][5][6][7][8][9][10] . All reported cases were found to be caused by high-energy trauma, and all esophageal perforations occurred due to upper thoracic vertebral fractures between T1 and T4.…”

Multidisciplinary management of thoracic esophageal fistula secondary to traumatic upper thoracic fracture (T3–4) with associated discitis/osteomyelitis and spinal epidural abscess: illustrative case

“…The proximity of the esophagus to the spinal column between C5 and T4 results in its vulnerability to spinal fracture, particularly hyperextension-type injuries, and possible esophageal disruptions and fistula formations. 4 …”

“…The proximity of the esophagus to the spinal column between C5 and T4 results in its vulnerability to spinal fracture, particularly hyperextension-type injuries, and possible esophageal disruptions and fistula formations. 4 The treatment of an esophageal fistula can involve conservative management with enteral diversion or direct closure of the defect with direct repair and or in combination with vascularized tissue. [5][6][7] An esophageal fistula complication has been documented in the cervical spine, with incidence rates ranging from 0% to 3.4%, 8,9 although this complication in the high thoracic spine has not been as well documented.…”

“…[5][6][7] An esophageal fistula complication has been documented in the cervical spine, with incidence rates ranging from 0% to 3.4%, 8,9 although this complication in the high thoracic spine has not been as well documented. Inoue et al 4 documented a summary of high thoracic spine cases with spinal trauma, which included esophageal perforation (Supplemental Table 1). Six of the seven cases had been rapidly diagnosed and conservatively treated and had a good prognosis.…”

Esophageal Trauma: Analysis of Incidence, Morbidity, and Mortality

“…Blunt ET is rare relative to penetrating ET and is postulated to cause ET because of high speed deceleration causing direct compression between the spine and surrounding structures. 11,12 In addition, the diagnosis of blunt ET is often delayed because of low clinical suspicion and other significant contributing injuries such as traumatic brain injury. 12 Therefore, we hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma.…”