RT Journal Article
SR Electronic
T1 Through-and-through gunshot wound to the esophagus at the thoracic inlet:a novel management approach
JF Trauma Surgery & Acute Care Open
FD BMJ Publishing Group Ltd
SP e000195
DO 10.1136/tsaco-2018-000195
VO 3
IS 1
A1 Nathan S Rubalcava
A1 Sharjeel Israr
A1 Jenna L Sitenga
A1 Vincent A Gemma
A1 Kevin P McGeever
A1 Jordan Weinberg
A1 Ross M Bremner
YR 2018
UL http://tsaco.bmj.com/content/3/1/e000195.abstract
AB A 42-year-old man presented to the emergency department with gunshot wound to left upper back over the scapula and palpable bullet over the right supraclavicular fossa. The patient had a left-sided needle thoracostomy in the field. He was tachypneic and tachycardiac but normortensive on arrival. Due to the patient being in respiratory distress, he was orotracheally intubated. On examination, he was found to have a moderate left pneumothorax with mild mediastinal shift. He had a left closed tube thoracostomy placed. CT angiography imaging of the neck and chest was then obtained, and pneumomediastinum associated with bony fragmentation of the anterior T1 and T2 vertebral bodies was observed. Additional findings included right internal jugular injury and right apical pulmonary hemorrhage. The patient subsequently underwent flexible tracheobronchoscopy and esophagoscopy in the endoscopy suite, where a through-and-through esophageal injury at 21 cm from the incisors was recognized (figure 1). There was erythema noted in the trachea at this level, but no evidence of transmural injury to the trachea.Figure 1 Through-and-through gunshot wound to esophagus. Arrows denote areas of injury.What would you do?Commence 14-day course of broad spectrum antibiotics.Endoscopic stenting with video-assisted thorascopic surgery (VATS) washout.Local exploration with wide drain placement.Open esophagectomy with spit fistula.