Recognition and Management of Nonaccidental Esophageal Perforation

Nonaccidental trauma is a common pediatric concern that often goes unrecognized. Although most patients present with bruising, burns, fractures, and head trauma, it is critical that physicians be able to diagnose and treat atypical presentations such as pharyngeal and esophageal trauma. In this report, we describe the presentation and management of a 5-week-old girl with an inflicted esophageal perforation.

Successful treatment of patient with thoracoabdominal injury with heart and esophageal trauma (clinical case).

The article presents a case of treating the patient with extrapleural thoracoabdominal injury with heart and esophageal trauma. Examination of the patient in a shock trauma operating room, the use of minimally invasive technologies (thoracoscopy, laparoscopy) allowed to choose the right treatment tactics, timely identify all injuries and eliminate them. The presented clinical observation demonstrates the feasibility of using video thoracoscopy and video laparoscopy in hemodynamically stable patients with penetrating thoracoabdominal wounds to detect damage to the heart and esophagus.

Esophageal Trauma: Analysis of Incidence, Morbidity, and Mortality

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010–2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma ( P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.

Complicaciones Asociadas Al Trauma Penetrante de Esófago, Experiencia De 11 Años En El Hospital Universitario de Neiva

ABSTRACT Background Penetrating esophageal lesions are extremely rare, less than 0.5%. They are related to high morbidity 30--66% and mortality ~20%. There is a diagnostic and therapeutic challenge, given its severity requires a timely approach and aggressive management to avoid sequelae and complications. Study design Descriptive subgroup analysis of a retrospective cohort (2003--2013) of patients with surgical trauma. The severity of the trauma was assessed using the AAST classification. Results Of the total 2,390 cases of registered surgical trauma, 10 (0.4%) corresponded to an esophageal trauma. All cases were observed in men with a median age of 26 years (IQR = 19--35). The cause of the most frequent injury was gunshot injury in six patients, followed by blunt gun injury in two patients and blast wave in the two remaining patients. The RTS in the majority of the patients was 7.84 (IQR = 7.47--7.84). The severity of esophageal trauma was grade II in seven patients and grade III in three patients. Associated vascular lesions were observed in two patients. All patients were taken to repair the primary lesion. The most frequent complication was esophageal tracheal fistula in four patients. A total of seven patients required reintervention, 71% for lesions directly related to esophageal lesion. No mortality was shown. Conclusion Esophageal lesions in surgical management trauma are infrequent, no deaths were observed in this series. Complications are common, the most commonly related is tracheoesofagic fistula, the reinterventions present an adequate evolution How to cite this article Rubio MA, Rubio JJ, Ospitia MA, Sanjuan JF, Medina R, Botache WF. Complicaciones Asociadas Al Trauma Penetrante de Esófago, Experiencia De 11 Años En El Hospital Universitario de Neiva. Panam J Trauma Crit Care Emerg Surg 2017;6(1):25-29.