DETECTION AND EVALUATION OF AERODIGESTIVE TRACT INJURIES CAUSED BY CERVICAL AND TRANSMEDIASTINAL GUNSHOT WOUNDS

Background: Aerodigestive tract penetrations occurring with gunshot wo unds to the neck and thorax are uncommon but are frequently associated with multiple organ injury and contribute to significant morbidity. M ethods: The selective management strategy used at our institution for suspected aerodigestive tract involvement with cervical, thoracic inle t, and transmediastinal gunshot wounds is reviewed with reference to e ight clinical cases from 1989 to 1995, Results: Seven pharyngoesophage al and four laryngotracheal injuries are described with three patients sustaining combined aerodigestive organ wounds, Associated injuries o ccurred in seven of the eight cases, Diagnosis of aerodigestive tract penetrations were made by triple endoscopy in five patients, by contra st esophagography in one case, and at operation for associated injurie s in two patients, No injuries were missed during endoscope or contras t studies, Two patients suffered complications including delayed recog nition of an esophageal injury and pneumonia in one case and dehiscenc e of a distal esophageal repair in another. lin associated vascular in jury resulted in a single death in the series, Conclusions: A high ind ex of suspicion must he maintained for aerodigestive tract involvement with cervicothoracic gunshot wounds. We advocate operative endoscopic inspection during emergent exploration in unstable patients or arteri ography with endoscopy in stable patients, Adjunctive contrast pharyng oesophagography is performed to confirm equivocal endoscopic findings, evaluate the extent of leak, or completely exclude injury.