Penetrating visceral injuries of the neck: Results of a conservative management policy

Ngakane, H.; Muckart, D. J. J.; Luvuno, F M

doi:10.1002/bjs.1800770822

Cited by 60 publications

(37 citation statements)

References 17 publications

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“…These 28 patients constituted 13% of patients with odynophagia associated with neck injuries. These findings are in keeping with those of Ngakane et al,9 where only 14% of patients with odynophagia were shown to have cervical oesophageal injury. Both these studies confirm that odynophagia alone is not pathognomonic of cervical oesophageal injury.…”

Section: Discussionsupporting

confidence: 92%

“…[9][10][11] Oesophageal injuries occurred in 2% of neck injuries in this series. There was an average of 4-5 oesophageal injuries per year, which falls within the rate of 2-9 cases per year reported by most busy trauma centres.…”

Section: Discussionmentioning

confidence: 65%

“…[9][10][11] This paper addresses the role of selective versus mandatory exploration only in patients with a determined oesophageal injury and proposes that the selective policy has merit in patients with proven oesophageal injury.…”

Section: Discussionmentioning

confidence: 99%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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Background: There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective. Patients and Methods: This is a retrospective study carried out over 5 years (1994)(1995)(1996)(1997)(1998). Of 1358 patients with neck trauma, 220 presented with odynophagia, of whom 28 were shown on contrast swallow to have cervical oesophageal injury (17 stabs, 11 firearms). Median age was 26 years (range, 11-44 years). There were 23 males (M:F ratio, 6:1). All patients with contained extravasation were managed non-operatively irrespective of the delay from injury to admission. Repair was undertaken in patients with major disruption and those requiring exploration for another reason. Associated tracheal injuries were repaired primarily with or without tracheostomy. Patients were fed using fine bore enteral feeding tubes. Oral feeding was recommenced after a water soluble contrast swallow had confirmed healing. Results: All patients presented with odynophagia. Seven had clinical surgical emphysema, and 15 had retropharyngeal air on lateral neck X-ray. Chest X-ray showed surgical emphysema in 8, haemothorax in 2 and pneumothorax in 2. Seventeen patients were managed non-operatively. Sixteen recovered with no complications, while one developed local sepsis. Eleven patients underwent exploration (debridement in 7 and primary repair in 4). There were 6 associated tracheal injuries, all of whom underwent primary repair with tracheostomy performed in four. Thirteen patients were admitted to the intensive care unit. Median duration of enteral tube feeding was 18 days (range, 5-40 days) and median hospital stay was 18 days (range, 6-91 days). Two patients with firearm injuries died from associated injuries. Conclusion: Non-operative management of penetrating injuries to the cervical oesophagus is safe and effective.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 65%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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“…Nonetheless, conservative measures were successfully used in 4 patients with ruptures ranging in length between 1 and 4 centimetres (cases 19, 20, 21 and 23). Such experience, even if limited to four cases, couples with previously reported series in suggesting that the conservative treatment plays a role in traumatic disruptions [20][21][22][23][24][25][26].…”

Section: Discussionsupporting

confidence: 59%

“…Nonetheless, a few cases and a few recent series have been reported with even wide full-thickness iatrogenic tracheal lacerations successfully managed by means of conservative treatment [10][11][12][13][14][15][16][17]. As far as traumatic ruptures are concerned, surgical treatment is advocated in most cases as well [18][19], but the conservative treatment has been reported also [20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Treatment of iatrogenic and traumatic tracheal disruptions

Leoncini¹,

Iurilli²,

Boni³

et al. 2016

Monaldi Arch Chest Dis

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Background and aim. The optimal management of tracheal disruptions is still controversial. It is usually postulated that lesions wider than 1 or 2 centimetres and/or lesions of full-thickness should be treated by surgery at an early stage. Such a statement is not supported by any proven evidence. On the contrary, the conservative management of such injuries has also produced very good results according to recent reports. The aim of this study is to investigate whether conservative treatment can be safely used for wide tracheal lacerations and to assess any possible association between clinical features and modality of treatment. Methods. Records of all patients with iatrogenic and traumatic tracheal disruptions observed between January 1992 and December 2006 were collected and retrospectively reviewed. Data regarding mechanism of injury, clinical and morphological features and modalities of treatment were registered. All possible associations between clinical features and modalities of treatment were investigated. Results. 23 patients were observed overall. There were 6 males and 17 females with a median age of 58 years (range 20-84 yrs). 15 patients had undergone single tube intubation. One patient had his trachea injured during an esophagectomy. Ruptures were secondary to blunt (n=5) and open (n=2) trauma in 7 patients. Lesions varied in length between 1 and 7 centimetres (median length 3 centimetres) and all were full-thickness. The time interval until diagnosis varied between 0 and 72 hours (median 6 hours). Respiratory failure was evident in 7 patients. 16 patients (69.5%) with lacerations ranging in length between 1 and 5.5 centimetres (median length 2.75 cm) underwent conservative treatment. Seven patients (30.5%) underwent surgery. The follow up was completed for 16 patients and varied between 15 and 105 months (median 22.5). One patient died after surgical treatment. No mortality or late major sequelae were registered after conservative treatment. Female sex, absence of respiratory failure and delayed diagnosis was associated with the conservative treatment. Conclusions. Conservative treatment can play a major role even in cases of wide tracheal lacerations. Clinical rather than morphological features should be regarded as main criteria for treatment. The conservative treatment is particularly indicated in the case of stable respiratory parameters independent of the size and the depth of the lesion.

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Physical Examination and Arteriography in Patients With Penetrating Zone II Neck Wounds

Beitsch

Weigelt²,

Flynn³

et al. 1994

Arch Surg

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Findings on physical examination are good predictors of arterial injury in patients with penetrating neck wounds and can exclude injury in over 99% of patients. Arteriography is a sensitive test but has a very low yield (1.4%). These findings question whether the current practice of mandatory neck exploration or proximity arteriography is necessary for patients without signs or symptoms of injury who have penetrating wounds of the neck.

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Penetrating visceral injuries of the neck: Results of a conservative management policy

Cited by 60 publications

References 17 publications

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Treatment of iatrogenic and traumatic tracheal disruptions

Physical Examination and Arteriography in Patients With Penetrating Zone II Neck Wounds

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