Transmediastinal gunshot injuries

Background. Transmediastinal gunshot injuries are a rarely reported injury. Until recently, assessment of the thoracic aorta by angiography preceded t he investigation of the esophagus. This order has been recently debated. Methods. There were 118 patients wit potential transmediastinal injuries in cluded in this retrospective study. Unstable patients who were unresponsive to resuscitation were taken to the operating room without previous investi gation. Stable patients were routinely investigated initially for injury of the aorta and then for injury of the esophagus. Results. There were 51 patients who underwent urgen thoracotomy/sternotomy. IN 27 the hemorrhage was of mediastinal origin; 17 of these patients died of intraoperative bleeding. Eight of the patients had aortic injury, and on ly one of this group survived. There were 57 stable patients who were inves tigated initially for injury of the aorta by angiography. It was positive i n only one patient who underwent an operation with good results. An investi gation of the esophagus followed and revealed esophageal injury in 17 patie nts. All of them were treated operatively, 15 of them wit satisfactory outc ome. Conclusions. Angiography should at present precede esophageal investigation s. There is a need for shortening the time between admission and operation. Other modalities that could expedite the investigation of the thoracic aor ta and the esophagus should be prospectively evaluated in multi-center stud ies.