Management of Warfare Chest Injuries

The battle trauma of the esophagus

Objective. Estimation of efficacy of diagnosis and methods of treatment in patients, suffering the battle trauma of the esophagus. Materials and methods. In the Division of Thoraco–Abdominal Surgery of the Shalimov National Institute of Surgery and Transplantology the treatment of 7 patients with penetrating esophageal wounds was conducted. In 6 (85.7%) patients the penetrating gun–shot woundings were diagnosed, and in 1 (14.3%) patient – the closed thoracic trauma. Shrapnel woundings prevailed over the bullet woundings, occurring in5 (71.4%) and 2 (28.6%) patients, accordingly. Esophageal trauma as isolated affection, caused by the gun–shot penetraiting wounding was extremely rare – in 1 (14.3%) patient. Efficacy of diagnosis and surgical stationary treatment of esophageal trauma, caused by foreign bodies, was estimated, as well as the terms of the esophagus integrity restoration. Results. In 2 (2.6%) patients with pleural empyema open toracotomy access with further pleurectomy, pulmonary decortication, and restoration of the esophageal wall integrity was applied. In 4 (57.2%) patients thoracoscopy, pleurectomy, pulmonary decortication, and esophageal suturing were conducted. Intraoperatively in 6 (85.7%) patients the endoscopic vacuum therapy system was installed locally in the damaged esophagus portion. In 1 (14.3%) patient with local pleural empyema the treatment tactics consisted of the pleural cavity drainage under ultrasonographic control plus endoscopic vacuum therapy. For achievement of its optimal efficacy the pressure value was supported in range from 100 to 120 mm Hg. Endoscopic vacuum system was changed every 4 – 5 days. Average duration of the fistulas healing have constituted 1mo.