NONIATROGENIC ESOPHAGEAL TRAUMA

Few guidelines are available with which to facilitate treatment in pat ients with noniatrogenic injuries of the esophagus. Early diagnosis an d proper management are essential if a good outcome is to be expected. In an effort to define better the treatment of patients with penetrat ing and blunt injuries of the esophagus, we report our recent 5-year e xperience at an urban trauma center. From July 1988 to June 1993, nine teen patients with esophageal perforations from penetrating (18) and b lunt (1) trauma were identified by our trauma registry. There was no m ortality in this group of patients and morbidity was mostly due to ass ociated injuries. Eleven cervical esophageal injuries were repaired. O ne cervical injury was treated by stopping oral intake and giving intr avenous antibiotics. The neck was not drained in 10 of the surgical ca ses. In 1 patient a tracheoesophageal fistula developed, which later w as repaired with a pectoralis muscle nap. Seven perforations were iden tified in the thoracic (2) and abdominal (5) portions of the esophagus . All were due to gunshot;wounds. In 4 cases, a fundal wrap was used t o reinforce the repairs. Postoperative contrast studies confirmed that all repairs were intact. We conclude that penetrating and blunt tears of the esophagus can be repaired safely with minimal mortality. Morbi dity is usually from associated injuries such as to the spinal cord an d trachea. When identified early, cervical esophageal injuries do not need to be drained routinely.