Thoracic esophageal injury due to a neck stab wound: a case report

Abstract

Background Traumatic esophageal injury leads to severe complications such as mediastinitis, pyothorax, and tracheoesophageal fistula. Although prompt diagnosis and treatment are required, there are no established protocols to guide diagnosis or treatment. In particular, thoracic esophageal injury tends to be diagnosed later than cervical esophageal injury because it has few specific symptoms. We report a case of thoracic esophageal injury caused by a cervical stab wound; the patient was stabbed with a sharp blade. Case presentation A 74-year-old woman was attacked with a knife while sleeping at home. The patient was taken to the emergency room with an injury localized to the left section of her neck. She was suspected of a left jugular vein and recurrent laryngeal nerve injury from cervical hematoma and hoarseness. On the day following the injury, computed tomography revealed a thoracic esophageal injury. Emergency surgery was performed for an esophageal perforation and mediastinal abscesses. Although delayed diagnosis resulted in suture failure, the patient was able to resume oral intake of food a month later following enteral feeding with a gastrostomy. Esophageal injuries due to sharp trauma are rare, and most are cervical esophageal injuries. There are very few reports on thoracic esophageal injuries. Conclusions The possibility of thoracic esophageal injury should always be considered when dealing with neck stab wounds, particularly those caused by an attack.

Esophageal Stab Wounds Repaired Endoscopically: A Case Report and Comprehensive Literature Review

“…Some iatrogenic EIs are traumatic and result from blunt wounds or penetration, but the majority of iatrogenic EIs result from intraoperative or endoscopy procedures [1]. Previous studies have observed that gunshot wounds are the most common cause of penetrating traumatic EIs, accounting for 47-75% of traumatic EIs [1][2][3]. Stab wounds follow close behind, accounting for 15% of penetrating EIs in the United States; however, the prevalence of stab wounds versus gunshot wounds varies depending on region and country [1][2][3].…”

“…Previous studies have observed that gunshot wounds are the most common cause of penetrating traumatic EIs, accounting for 47-75% of traumatic EIs [1][2][3]. Stab wounds follow close behind, accounting for 15% of penetrating EIs in the United States; however, the prevalence of stab wounds versus gunshot wounds varies depending on region and country [1][2][3]. Even in high-influx trauma centers, EIs account for 1-6% of all trauma cases per year, and, overall, the incidence of traumatic EIs is very low worldwide [1,4].…”

“…The presentation and mechanism of injury differ based on the three regions of the esophagus, in which EIs occur [ 1 ]. Injuries to the cervical esophagus are the most common and can be further classified by zones [ 1 , 2 ]. From the clavicle to the cricoid cartilage is zone I, and from the level of the cricoid to the mandibular angle is zone II, where more than 80% of cervical neck injuries occur [ 2 ].…”

“…Injuries to the cervical esophagus are the most common and can be further classified by zones [ 1 , 2 ]. From the clavicle to the cricoid cartilage is zone I, and from the level of the cricoid to the mandibular angle is zone II, where more than 80% of cervical neck injuries occur [ 2 ]. Zone III extends to the base of the skull [ 2 ].…”

“…From the clavicle to the cricoid cartilage is zone I, and from the level of the cricoid to the mandibular angle is zone II, where more than 80% of cervical neck injuries occur [ 2 ]. Zone III extends to the base of the skull [ 2 ]. The cervical esophagus is contained between the trachea and spine anteriorly and posteriorly, with the carotid sheath on either side, making this region of high importance [ 1 ].…”