Esophageal Trauma: Analysis of Incidence, Morbidity, and Mortality

Abstract

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010–2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma ( P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.

A narrative review of traumatic mediastinal injuries and their management: the thoracic surgeon perspective

“…Esophageal injuries are only estimated to account for 0.02–1% of all traumatic injuries, with many individuals dying on scene from exsanguination secondary to co-injury of the great vessels ( 16 , 17 - 23 ). If present these injuries pose significant morbidity (upwards of 70%) and mortality (40–53%) ( 17 , 21 , 24 ). Esophageal trauma can be categorized based on location (cervical, thoracic or abdominal), as well as mechanism (blunt or penetrating) ( 24 ).…”

“…If present these injuries pose significant morbidity (upwards of 70%) and mortality (40–53%) ( 17 , 21 , 24 ). Esophageal trauma can be categorized based on location (cervical, thoracic or abdominal), as well as mechanism (blunt or penetrating) ( 24 ). Esophageal injury in trauma is thought to be upwards of 16 times more common in penetrating injuries where the cervical esophagus is most commonly affected ( 23 - 25 ).…”

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

“…Traumatic esophageal injury reportedly occurs in only 0.01% of chest injuries 1 . However, once esophageal perforation occurs, it can be life-threatening and should be cautiously diagnosed.…”

A Review of “Options in Management of Trauma to the Esophagus” (1982) “Submitted for the Literary Festschrift in Honor of J. David Richardson, MD”

“…Penetrating and blunt injuries to the esophagus remain rare, with the majority of injuries being iatrogenic or endoluminal in origin. [2][3][4][5][6][7] Penetrating trauma causes more esophageal injuries than blunt trauma, though these still occur in only .7% of patients with penetrating chest wounds. 9 Several reviews from both the National Trauma Data Bank and the Trauma Quality Improvement Program have noted a high percentage of additional organs injured, such as ribs and lungs, depending on the mechanism and due to the location of the esophagus deep in the thorax.…”

“…7 Morbidity and mortality rates remain high due to associated vascular injuries in the neck and chest and are similar after blunt or penetrating trauma. 2 Aiolfi et al 6 found that age >50, thoracic injury, high-grade esophageal injury (OIS IV–V), hypotension on admission, and GCS <9 were independent risk factors for increased mortality.…”