June 1976

Esophageal Disruption From Blunt and Penetrating External Trauma

Author Affiliations

From the Division of Thoracic Surgery, Harbor General Hospital Campus of the University of California at Los Angeles School of Medicine.

Arch Surg. 1976;111(6):663-667. doi:10.1001/archsurg.1976.01360240043007

• Eleven patients suffered esophageal perforations from external trauma. This series includes the first report of esophageal perforation that resulted from a cervical flexion-hyperextension injury. The other ten patients had penetrating trauma.

Early signs were subtle. Small amounts of mediastinal and cervical air tended to be overlooked or erroneously attributed to other causes, such as associated pneumothorax. Once suspected, the possibility of esophageal disruption was not always pursued with optimum vigor. There was undue reliance on contrast media radiography. There were two patients with falsely normal esophagograms.

All patients healed well when treated within 12 hours after injury by primary closure and drainage. All three patients treated after 12 hours of delay required secondary drainage for cervicomediastinal sepsis, and one of them died.

Possible esophageal injury needs to be suspected after blunt as well as penetrating cervicothoracic trauma. When time permits, endoscopy, esophagogram, and bronchoscopy should be the minimum preoperative workup. Prompt primary closure of externally induced esophageal perforations is the treatment of choice.

(Arch Surg 111:663-667, 1976)