Conservative treatment in isolated penetrating cervical esophageal injury: case report

Imaging of Neck Visceral Trauma

The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.

Conservative management of gunshot oesophageal injuries: A report of two consecutive exceptional cases

INTRODUCTION

Oesophageal trauma carries high mortality and morbidity. For penetrating intrathoracic oesophageal injury, surgical repair has been the standard for decades to avoid its devastating consequences.

CASE REPORT

Both patients presented with a thoracoabdominal gunshot wound and retained intraabdominal missile. Although there were no visible signs of perforation on oesophagoscopy or contrast swallow, the presence of an intraluminal bullet highly suggested a thoracic oesophageal injury.

DISCUSSION

Non-operative management of intrathoracic oesophageal perforation is controversial. Small perforations or contained leaks diagnosed within 24-48 h in a stable patient with no mediastinitis or empyema can be managed non-operatively with antibiotics and nasogastric feeds. These two case reports support the notion of selective non-operative management of asymptomatic patients with penetrating injury to the oesophagus.