Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 7 , ISSUE 1 ( January-April, 2018 ) > List of Articles

RESEARCH ARTICLE

Blunt Esophageal Injury and Importance of Early Diagnosis: A National Trauma Data Bank Analysis

Mario F Gomez

Keywords : Blunt trauma, Esophageal trauma, Outcomes, Primary suture

Citation Information : Gomez MF. Blunt Esophageal Injury and Importance of Early Diagnosis: A National Trauma Data Bank Analysis. Panam J Trauma Crit Care Emerg Surg 2018; 7 (1):61-65.

DOI: 10.5005/jp-journals-10030-1205

License: CC BY-NC 4.0

Published Online: 04-04-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

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.


PDF Share
  1. Petrone P, Kassimi K, Jiménez-Gómez M, Betancourt A, Axelrad A, Marini CP. Management of esophageal injuries secondary to trauma. Injury 2017 Aug;48(8):1735-1742.
  2. Wu JT, Mattox KL, Wall MJ. Esophageal perforations: new perspectives and treatment paradigms. J Trauma 2007 Nov;63(5):1173-1184.
  3. Biffl WL, Moore EE, Feliciano DV, Albrecht RA, Croce M, Karmy-Jones R, Namias N, Rowell S, Schreiber M, Shatz DV, et al. Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries. J Trauma Acute Care Surg 2015 Dec;79(6):1089-1095.
  4. Cedeño A, Echeverría K, Vázquez J, Delgado A, Rodríguez- Ortiz P. Intrathoracic esophageal rupture distal to the carina after blunt chest trauma: Case-report. Int J Surg Case Rep 2015 Sep;16:184-186.
  5. Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004 Apr;77(4):1475-1483.
  6. Bernard AW, Ben-David K, Pritts T. Delayed presentation of thoracic esophageal perforation after blunt trauma. J Emerg Med 2008 Jan;34(1):49-53.
  7. Asensio JA, Chahwan S, Forno W, MacKersie R, Wall M, Lake J, Minard G, Kirton O, Nagy K, Karmy-Jones R, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma 2001 Feb;50(2):289-296.
  8. Aiolfi A, Inaba K, Recinos G, Khor D, Benjamin ER, Lam L, Strumwasser A, Asti E, Bonavina L, Demetriades D. Non-iatrogenic esophageal injury: a retrospective analysis from the National Trauma Data Bank. World J Emerg Surg 2017 Apr;12:19.
  9. Cordero JA, Kuehler DH, Fortune JB. Distal esophageal rupture after external blunt trauma: report of two cases. J Trauma 1997 Feb;42(2):321-322.
  10. Mezuki S, Shono Y, Akahoshi T, Hisanaga K, Saeki H, Nakashima Y, Momii K, Maki J, Tokuda K, Maehara Y. Esophageal perforation due to blunt chest trauma: Difficult diagnosis because of coexisting severe disturbance of consciousness. Am J Emerg Med 2017 Nov;35(11):1790.e3-1790.e5.
  11. Beal SL, Pottmeyer EW, Spisso JM. Esophageal perforation following external blunt trauma. J Trauma 1988 Oct;28(10): 1425-1432.
  12. Oray NC, Sivrikaya S, Bayram B, Egeli T, Dicle O. Blunt trauma patient with esophageal perforation. West J Emerg Med 2014 Sep;15(6):659-662.
  13. Beer-Furlan A, Brock RS, Mendes LS, Mutarelli EG. Minor blunt cervical spine trauma associated with esophageal perforation and epidural empyema. Acta Neurol Belg 2016 Dec;116(4):691-693.
  14. Felmly LM, Kwon H, Denlinger CE, Klapper JA. Esophageal perforation: a common clinical problem with many different management options. Am Surg 2017 Aug;83(8):911-917.
  15. Graziosi L, Marino E, Donini A. Stent placement in the management of esophageal leaks. Ann Thorac Surg 2016 Nov;102(5):1762-1763.
  16. Dalal S, Dalal N, Goyal P. Isolated esophageal injury following blunt thoracic trauma: a rarity. Gastroenterology Res 2009 Oct;2(5):307-308.
  17. Andrade-Alegre R. Surgical treatment of traumatic esophageal perforations: analysis of 10 cases. Clinics (Sao Paulo) 2005 Oct;60(5):375-380.
  18. Bryant AS, Cerfolio RJ. Esophageal trauma. Thorac Surg Clin 2007 Feb;17(1):63-72.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.