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Papaconstantinou D, Kapetanakis EI, Mylonakis A, Davakis S, Kotidis E, Tagkalos E, Rouvelas I, Schizas D. Current aspects in the management of esophageal trauma: a systematic review and proportional meta-analysis. Dis Esophagus 2024; 37:doae007. [PMID: 38366609 DOI: 10.1093/dote/doae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
Trauma-related esophageal injuries (TEIs) are a rare but highly lethal condition. The presentation of TEIs is very diverse depending on the location and mechanism of injury (blunt vs. penetrating), as well as the presence or absence of concurrent injuries. The aim of the present systematic review and meta-analysis is to delineate the clinical features impacting TEI management. A systematic review of the Medline, Embase, and web of science databases was undertaken for studies reporting on patients with TEIs. A random effects model was employed in the meta-analysis of aggregated data. Eleven studies, incorporating 4605 patients, were included, with a pooled mortality rate of 19% (95% confidence interval (CI) 13-25%). Penetrating injuries were 34% more likely to occur (RR 0.66, 95% CI 0.49-0.89, P = 0.01), predominantly in the neck compartment. Surgery was employed in 53% of cases (95% CI 32-73%), with 68% of patients having associated injuries (95% CI 43-94%). In terms of choice of surgical repair technique, primary suture repair was most frequently reported, irrespective of injury location. Postoperative drainage was employed in 27% of the cases and was more common following repair of thoracic esophageal injuries. The estimated dependence on mechanical ventilation was 5.91 days (95% CI 5.1-6.72 days), while the length of stay in the intensive care unit averaged 7.89 days (95% CI 7.14-8.65 days). TEIs are uncommon injuries in trauma patients, associated with considerable mortality and morbidity. Open suture repair of ensuing esophageal defects is by large the most employed approach, while stenting may be indicated in carefully selected cases.
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Affiliation(s)
- Dimitrios Papaconstantinou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Adam Mylonakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Spyridon Davakis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Efstathios Kotidis
- Fourth Department of Surgery, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Evangelos Tagkalos
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ioannis Rouvelas
- Center for Digestive Diseases, Karolinska University Hospital and the Division of Surgery and Oncology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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2
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Chirica M, Bonavina L. Esophageal emergencies. Minerva Surg 2023; 78:52-67. [PMID: 36511315 DOI: 10.23736/s2724-5691.22.09781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.
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Affiliation(s)
- Mircea Chirica
- Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France -
| | - Luigi Bonavina
- Medical School, Division of General Surgery, IRCCS San Donato Polyclinic, University of Milan, Milan, Italy
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3
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Kanlerd A, Mahawongkajit P, Achavanuntakul C, Boonyasatid P, Auksornchart K. Successful management of 72-h delay-detected blunt esophageal injury with trans-gastric primary repair; a case report and literature review. Trauma Case Rep 2023; 43:100755. [PMID: 36654763 PMCID: PMC9841267 DOI: 10.1016/j.tcr.2023.100755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/08/2023] Open
Abstract
Diagnosis of blunt esophageal injury is currently a challenging issue. Early surgical interventions still play as the mainstay of treatment. There was no consensus about appropriate treatment options. However, it was potential morbidity if delayed management. We report a 33-year-old man with a history of a motorcycle accident who presented with hematemesis and epigastrium pain. He was initially diagnosed with left pneumohemothorax and low-grade gastric injury. The patient developed a high-grade fever with complex left pneumohemothorax 72-h after admission. The diagnostic studies revealed a lower esophageal rupture. He was treated with trans-gastric primary repair and recovered well with no complications. We propose the trans-gastric intraluminal repair is one of the surgical options in a blunt lower esophageal rupture.
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Affiliation(s)
- Amonpon Kanlerd
- Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand,Corresponding author at: Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, 95 M.8 Paholyotin Rd., Klongluang, Pathumthani 12120, Thailand.
| | - Prasit Mahawongkajit
- Gastrointestinal Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chompoonut Achavanuntakul
- Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Piyapong Boonyasatid
- Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Karikarn Auksornchart
- Trauma and Surgical Critical Care Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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4
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Llorente K, Evans M, Moore SA, Miskimins R. Endoluminal wound VAC therapy for the management of esophageal trauma: A case series. Trauma Case Rep 2022; 43:100748. [PMID: 36632331 PMCID: PMC9826891 DOI: 10.1016/j.tcr.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Esophageal trauma is rare and associated with high morbidity and mortality. Management can be challenging. Operative intervention involves exposure of the esophageal injury followed by primary two-layer repair with or without a buttressing muscle flap and wide local drainage. Repair can be complicated by post-operative leak and esophagocutaneous fistula. Endoluminal wound VAC therapy in the management of non-traumatic and iatrogenic esophageal perforations has shown efficacy. Presented here is a case series of four patients who sustained penetrating trauma to the esophagus and were managed successfully with endoluminal wound VAC therapy following primary repair. Therefore, endoscopic placement of an endoluminal wound VAC over the site of esophageal injury can serve as a safe and effective adjunct to primary repair of penetrating esophageal trauma. This procedure allows for frequent direct visualization of the injury as it heals, controls leakage of luminal contents, and promotes granulation for local wound healing.
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5
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Cheadle GA, Cheadle WG. A Review of "Options in Management of Trauma to the Esophagus" (1982) "Submitted for the Literary Festschrift in Honor of J. David Richardson, MD". Am Surg 2021; 87:183-187. [PMID: 33522267 DOI: 10.1177/0003134820988816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is an update of a paper which Dave Richardson and I published in 1982, and serves as both an update of management of esophageal injuries and as a lasting tribute to my mentor and hero J. David Richardson.
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Affiliation(s)
- Gerald A Cheadle
- Chief Resident in General Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
| | - William G Cheadle
- Chief Resident in General Surgery, 5170University of Louisville School of Medicine, Louisville, KY, USA
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6
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Contemporary management of traumatic cervical and thoracic esophageal perforation: The results of an Eastern Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2020; 89:691-697. [PMID: 32590561 DOI: 10.1097/ta.0000000000002841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic esophageal perforation is rare and associated with significant morbidity and mortality. There is substantial variability in diagnosis and treatment. Esophageal stents have been increasingly used for nontraumatic perforation; however, stenting for traumatic perforation is not yet standard of care. The purpose of this study was to evaluate current management of traumatic esophageal perforation to assess the frequency of and complications associated with esophageal stenting. METHODS This was an Eastern Association for the Surgery of Trauma multi-institutional retrospective study from 2011 to 2016 of patients with traumatic cervical or thoracic esophageal injury admitted to one of 11 participating trauma centers. Data were collected and sent to a single institution where it was analyzed. Patient demographics, injury characteristics, initial management, complications, and patient mortality were collected. Primary outcome was mortality; secondary outcomes were initial treatment, esophageal leak, and associated complications. RESULTS Fifty-one patients were analyzed. Esophageal injuries were cervical in 69% and thoracic in 31%. Most patients were initially managed with operative primary repair (61%), followed by no intervention (19%), esophageal stenting (10%), and wide local drainage (10%). Compared with patients who underwent operative primary repair, patients managed with esophageal stenting had an increased rate of esophageal leak (22.6% vs. 80.0%, p = 0.02). Complication rates were higher in blunt compared with penetrating mechanisms (100% vs. 31.8%, p = 0.03) despite similar Injury Severity Score and neck/chest/abdomen Abbreviated Injury Scale. Overall mortality was 9.8% and did not vary based on location of injury, mechanism of injury, or initial management. CONCLUSION Most patients with traumatic esophageal injuries still undergo operative primary repair; this is associated with lower rates of postoperative leaks as compared with esophageal stenting. Patients who have traumatic esophageal injury may be best managed by direct repair and not esophageal stenting, although further study is needed. LEVEL OF EVIDENCE Therapeutic, level IV.
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7
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Gambhir S, Grigorian A, Swentek L, Maithel S, Sheehan BM, Daly S, Lekawa M, Nahmias J. Esophageal Trauma: Analysis of Incidence, Morbidity, and Mortality. Am Surg 2020. [DOI: 10.1177/000313481908501012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Sahil Gambhir
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Areg Grigorian
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Lourdes Swentek
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Shelley Maithel
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Brian M. Sheehan
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Shaun Daly
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Michael Lekawa
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine Medical Center, Orange, California
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8
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Bautz B, Schneider JI. High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update). Emerg Med Clin North Am 2020; 38:453-498. [PMID: 32336336 DOI: 10.1016/j.emc.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism. Important aspects of clinical evaluation, diagnostic testing, treatment, and disposition and other less common causes of lethal chest pain are also discussed.
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Affiliation(s)
- Benjamin Bautz
- Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Jeffrey I Schneider
- Department of Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA; Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA.
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9
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Petrone P, Velaz-Pardo L, Gendy A, Velcu L, Brathwaite CEM, Joseph DK. Diagnosis, management and treatment of neck trauma. Cir Esp 2019; 97:489-500. [PMID: 31358299 DOI: 10.1016/j.ciresp.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 11/15/2022]
Abstract
Trauma injuries to the neck account for 5-10% of all trauma injuries and carry a high rate of morbidity and mortality, as several vital structures can be damaged. Currently, there are several treatment approaches based on initial management by zones, initial management not based on zones and conservative management of selected patients. The objective of this systematic review is to describe the management of neck trauma.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU..
| | - Leyre Velaz-Pardo
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Amir Gendy
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Laura Velcu
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - Collin E M Brathwaite
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
| | - D'Andrea K Joseph
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola, Nueva YorkEE. UU
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10
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Xu AA, Breeze JL, Jackson CCA, Paulus JK, Bugaev N. Comparative analysis of traumatic esophageal injury in pediatric and adult populations. Pediatr Surg Int 2019; 35:793-801. [PMID: 31076868 DOI: 10.1007/s00383-019-04481-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Distribution and outcomes of traumatic injury of the esophagus (TIE) in pediatric versus adult populations are unknown. Our study sought to perform a descriptive analysis of TIE in children and adults. METHODS We reviewed the National Trauma Data Bank (NTDB) for the years 2010-2015. Demographics, characteristics, and outcomes of pediatric (age < 16 years) and adult TIE patients were described and compared. RESULTS Among 526,850 pediatric and 3,838,895 adult trauma patients, 90 pediatric (0.02%) and 1,411 (0.04%) adult TIE patients were identified. Demographics and esophageal injury severity did not differ. Children were more likely to sustain blunt trauma (63% versus 37%), with the most common mechanism being transportation-related accidents, were less-severely injured (median ISS 14 versus 22), and had fewer associated injuries (79% versus 95%) and complications (30% versus 51%) (all p < 0.001). Children had shorter hospitalizations (median 5 versus 10 days) and were more likely to be discharged home (84% versus 64%) (both p = 0.01). In-hospital mortality did not differ significantly between children and adults (10% versus 19%, p = 0.09). CONCLUSION TIE in the pediatric population has unique characteristics compared to adults: it is more likely to be a result of blunt trauma, has lower injury burden, and has more favorable clinical outcomes.
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Affiliation(s)
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Carl-Christian A Jackson
- Floating Hospital for Children at Tufts Medical Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA, USA
| | - Nikolay Bugaev
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, #4488, Boston, MA, 02111, USA.
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11
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Chirica M, Kelly MD, Siboni S, Aiolfi A, Riva CG, Asti E, Ferrari D, Leppäniemi A, Ten Broek RPG, Brichon PY, Kluger Y, Fraga GP, Frey G, Andreollo NA, Coccolini F, Frattini C, Moore EE, Chiara O, Di Saverio S, Sartelli M, Weber D, Ansaloni L, Biffl W, Corte H, Wani I, Baiocchi G, Cattan P, Catena F, Bonavina L. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019; 14:26. [PMID: 31164915 PMCID: PMC6544956 DOI: 10.1186/s13017-019-0245-2] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
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Affiliation(s)
- Mircea Chirica
- 1Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Stefano Siboni
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Alberto Aiolfi
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Carlo Galdino Riva
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Emanuele Asti
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Davide Ferrari
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | - Ari Leppäniemi
- Department of Emergency Surgery, University Hospital Meilahti Abdominal Center, Helsinki, Finland
| | - Richard P G Ten Broek
- 5Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre Yves Brichon
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Yoram Kluger
- 7Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Gustavo Pereira Fraga
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Gil Frey
- 6Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Nelson Adami Andreollo
- 8Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Federico Coccolini
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | | | | | - Osvaldo Chiara
- 12General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Salomone Di Saverio
- 13Cambridge Colorectal Unit, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK
| | | | - Dieter Weber
- 15Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- 9General, Emergency and Trauma Surgery Department, Bufalini Hospital Cesena, Cesena, Italy
| | - Walter Biffl
- 16Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Helene Corte
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Imtaz Wani
- 18Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Pierre Cattan
- 17Department of Surgery, Saint Louis Hospital, Paris, France
| | - Fausto Catena
- 20Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Luigi Bonavina
- 3Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
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12
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Xu AA, Breeze JL, Paulus JK, Bugaev N. Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank. Am Surg 2019. [DOI: 10.1177/000313481908500422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.
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Affiliation(s)
| | - Janis L. Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Jessica K. Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts; and
| | - Nikolay Bugaev
- Division of Trauma & Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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13
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Selective nonoperative management of pharyngoesophageal injuries secondary to penetrating neck trauma: A single-center review of 86 cases. J Trauma Acute Care Surg 2018; 85:541-548. [PMID: 29787546 DOI: 10.1097/ta.0000000000001973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This article describes our experience with penetrating pharyngoesophageal injuries (PEI) in the light of a selective conservative approach, and has the objective to define criteria for nonoperative management (NOM). METHODS This retrospective single-center review of patients with penetrating neck injury treated for confirmed PEI over a 6-year period aimed to test our proposed hypothesis that NOM is safe for hemodynamically stable patients with PEI, who have no competing indications for exploration, have no established sepsis, and who have a water-soluble contrast swallow either showing no- or a contained extravasation. RESULTS Eighty-six (9%) patients with PEI (oropharynx, 17; hypopharynx, 40; esophagus, 29) of 948 patients with penetrating neck injury were included. Of the cohort 38 (44%) underwent NOM (oropharynx, 15 [88%]; hypopharynx, 18 [45%]; esophagus, 5 [17%]), and 48 (56%) were managed operatively. The median length of stay was 12 days (interquartile range, 19-8). Fifteen (17%) had a persistent leak and six (7%) mediastinitis. Five (6%) patients died but only one (1%) had isolated PEI. Retrospectively, 27 patients fulfilled our proposed criteria for NOM of which 23 had been treated actively by NOM (oropharynx, 8; hypopharynx, 12; esophagus, 3). For these patients, the length of stay was 10.0 days (interquartile range, 13-6), and none developed deep wound sepsis, mediastinitis, persistent leaks, or died. Of the remaining patients treated by NOM without fulfilling the proposed criteria, two were palliated (esophagus) and 13 were managed actively (oropharynx, 7; hypopharynx, 6). Only four of these patients (oropharynx, 1; hypopharynx, 3) were assessed with water-soluble contrast swallow, which showed noncontained extravasation, and three complicated with persistent leaks. CONCLUSION Nonoperative management of PEI is safe for a carefully selected subgroup of patients. However, most injuries to the caudal part of the cervical digestive tract mandate urgent exploration. LEVEL OF EVIDENCE Clinical Management Study, Level V evidence.
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14
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Injuries to the Aerodigestive Tract. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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