Trauma: Esophagus Trauma
Esophagus
General
- Most Common in Penetrating Trauma
- Most Common Site: Cervical #1, Thoracic #2 & Abdominal #3
- Virtually All Have Other Concomitant Injuries
AAST Esophagus Injury Scale
- *See AAST
- Injury Scale is Under Copyright
Diagnosis
- Patient Extubated & Able to Swallow: Water-Soluble Esophagram
- If Negative but High-Suspicion: Dilute-Barium Esophagram
- If Again Negative: Esophagoscopy
- Intubated or Unable to Swallow: Esophagoscopy
- Delay in Diagnosis Common
- Specificity:
- Contrast Studies Have High False-Negative Rates (25%)
- Negative Esophagram & Esophagoscopy Near 100% Specificity
Traumatic Esophagus Perforation with Contrast Extravasation 1
Treatment
- Primary Tx: Surgical Repair, Buttress & Leave Drain
- Repair
- First Extend Myotomy – To See Full Length of Mucosal Injury
- Close in Two Layers: Inner Absorbable, Outer Permanent
- Strength Layer: Submucosa (No Serosa)
- Direction:
- Small: Transversely
- Larger (> 2-3 cm): Longitudinally
- If Penetrating Injury: Explore Circumference to Verify No Back-Wall Injury
- Buttress
- Strengthens & Enhance Healing Given no Serosal Layer
- Neck: Strap Muscles or SCM
- Proximal Thorax: Intercostals or Rhomboid Muscle
- Muscle Flaps Preferred (Less Friable & More Bulky Coverage)
- Other Less Desirable Options: Pericardium or Pleura
- Distal Thorax or Abdomen: Stomach (Nissen Fundoplication)
- If Unable to Perform Nissen: Diaphragm
- Drains
- Neck: Penrose or JP Drain
- Thoracic: Chest Tubes
- Abdomen: JP Drain
- Repair
- Devastating Injury (Repair Not Feasible):
- Neck: Cervical Esophagostomy (Spit Fistula)
- Loop Esophagostomy If Able – Allows One-Stage Closure
- End Esophagostomy Requires Complex Closure
- Thoracic: T-Tube (Creates a Controlled Fistula)
- Neck: Cervical Esophagostomy (Spit Fistula)
References
- Oikonomou A, Prassopoulos P. CT imaging of blunt chest trauma. Insights Imaging. 2011 Jun;2(3):281-295. (License: CC BY-4.0)
