Learning the hard way: when a CT scan misleads your diagnosis

Western Journal of Emergency Medicine, 2014

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2018

Objective: Blunt esophageal trauma is a rare entity. The aim of this study is to examine current management strategies, and determine risk factors associated with complications and mortality in the National Trauma Data Bank (NTDB). Materials and methods: Using the NTDB from 2012, we identified adult patients who suffered blunt esophageal trauma. Patients were categorized undergoing early vs delayed management of esophageal injuries. Data collected included age, injury severity score (ISS), abbreviated injury score, length of stay, ventilation days, systolic blood pressure (SBP), time to procedure, comorbidities, esophageal-related procedures, complications, and disposition. Univariate and multivariable analysis were conducted to identify significant predictors of complications and mortality. Results: We identified 160 adult patients with blunt esophageal injuries in the NTDB, of which 78 patients (49%) had data on specific management of the esophageal injury. Forty-five patients (58%) underwent early operative management and 33 (42%) had delayed operative management. Of patients in the early group, 31 (63%) had primary repair, 11 (24.4%) esophageal graft, and 3 (6.6%) esophageal tube placement. In the delayed operative group, 4 (12%) had primary repair, 14 (42%) esophageal graft, 10 (30%) esophageal tube placement, and 5 (15%) had drainage. Early diagnosis was associated with a higher definitive primary repair rate. Mortality was similar between both groups (15.5 and 24.4%, p = 0.336). The delayed group was associated with increased risk of pulmonary complications. Both groups were similar in age, gender, and race. Significant predictors of esophageal-related complications were Abbreviated Injury Scale (AIS) ≥3 and ISS. Conclusion: Although rare, high index of suspicion for early detection of blunt esophageal injury must be maintained. Early operative management was associated with an increased rate of primary repair of the injury and decreased pulmonary complications.

Curēus, 2024

Annals of The Royal College of Surgeons of England, 2003

World journal of emergency surgery : WJES, 2017

Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant morbidity and mortality. The optimal management of these esophageal perforations remains largely debated. To date, only a few small case series are available with contrasting results. The purpose of this study was to examine a large contemporary experience with traumatic esophageal injury management and to analyze risk factors associated with mortality. This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal injuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS), esophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate analysis was used to identify independent predictors for mortality and overall complications. A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The...

International Surgery Journal, 2016

An esophageal perforation due to blunt trauma to chest is extremely rare and most often associated with road traffic accidents at high speeds. Symptoms and signs associated with esophageal perforation are non-specific and easily confused with other injuries common in polytrauma patients. The condition carries a significant morbidity and mortality and any delay in diagnosis further worsens the prognosis for the patient. We report a case of late presentation of post-traumatic esophageal perforation present below the level of carina in a young male who was managed conservatively.

Bhutan Health Journal

With the increasing incidence of corrosive oesophageal injuries, especially in the developing countries, understanding thepathophysiology and the approach to its management in the emergency and elective settings has become of paramount importance for the surgeon. The approach to the management varies depending on the time of the diagnosis and the location of injury. Endoscopy plays a key role as the first step in the evaluation of such patients in the emergency as well as late elective setting. With the advancement in endoscopic interventions, there has been a shift of preference towards the less invasive and less morbid endoscopic techniques to address the late sequelae of corrosive oesophageal injuries. Refractory cases eventually merit surgery, even at the cost of the morbidity and mortality associated with such rocedures. The surgical approach also varies depending on the location of the stricture, with the proximal 1/3rd strictures epresenting the most challenging location. A ...

The American Surgeon, 2019

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...

Current Trauma Reports, 2015

Blunt injury to the aorta, diaphragm, and esophagus are unusual and are typically the result of a significant transfer of energy and hence are typically accompanied by other injuries. The associated injury can detract attention, leading to lethal delays in the recognition of blunt injury to the aorta, esophagus, and diaphragm. Improved cross-sectional imaging techniques (CT scanning) and a better understanding of the subtle signs of blunt injury to the aorta, diaphragm, and even esophagus has lessened, but not eliminated, the delay in diagnosis. Changes in management of aortic injuries continue to involve, largely stimulated by the more widespread application of endovascular techniques, and a better understanding of the natural history of less severe grades of injury. Early and primary repair of an acute blunt diaphragm injury remains the standard. Blunt esophageal injury, perhaps the rarest in this category, can largely be excluded on the basis of a detailed thoracic CT scan, although the role of esophageal endoscopy or esophagography remains essential diagnostic tools. The management of these rare injuries is often controversial. This review will examine the recent literature regarding these uncommon injuries, emphasizing recent clinical trials and guidelines.

Einstein (São Paulo), 2012