Esophagogastric Trauma in Scotland

Abstract

Esophagogastric trauma occurs predominantly in young males. The incidence of GT, although low, is five times that of ET. Predominant mechanisms of GT are penetrating compared with blunt for ET. Both ET and GT are commonly found in the presence of other multiple injuries, and are associated with high mortality. Operative management of GT is associated with reduced mortality, but outcome is worse for patients with hemodynamic compromise, low GCS, and high ISS.

Total Esophageal Avulsion at the Esophagogastric Junction after Blunt Trauma

“…Esophageal injuries are rare because the elasticity, mobility, and secluded position of the esophagus protect it from blunt trauma; however, if injured, management of an esophageal injury is a challenge for the surgeon [1, 2]. Esophageal leakage is the main problem, as it may cause mediastinitis, pneumonia, sepsis, or death [1, 2].…”

“…Esophageal leakage is the main problem, as it may cause mediastinitis, pneumonia, sepsis, or death [1, 2]. Treatment of esophageal leakage after failure of an anastomosis and iatrogenic perforation is mostly medical, but after traumatic injury, it is mostly surgical [1, 2]. Saliva and gastric acid contents may leak after opening the esophagus.…”

“…If the diagnosis is delayed, fluid and solid food may leak. Early treatment is the most important factor for morbidity and mortality due to esophageal damage [1, 2]. However, management of a total avulsion and transection of the esophagus at the esophagogastric junction is very challenging for the surgeon even if it is diagnosed early.…”

“…However, they occur in <1% of all traumatic injuries but are associated with a significant risk of morbidity and mortality (6%–70%) [1, 2]. The outcome of esophageal injuries is determined by several factors that increase the risk of complications and death.…”

“…The outcome of esophageal injuries is determined by several factors that increase the risk of complications and death. A delay in diagnostic studies to determine the presence of these injuries and the difficulty identifying these injuries, particularly when other life-threatening injuries are present, can be problematic [1, 2]. Late surgical intervention for esophageal injuries is the most important determinant of the high rates of mortality and morbidity [1, 2].…”