| dc.description.abstract |
INTRODUCTION: Mortality after esophageal perforation is high irrespective of the treatment modality.
The rarity of traumatic esophageal perforations has made it difficult to conduct comprehensive studies
that can answer pertinent questions with regard to management.
PRESENTATION OF CASE: We report a case of through and through thoracic esophageal injury caused by an
assailant’s arrow in a young physically active male adult. Diagnosis was made on-table. He successfully
underwent primary repair of the esophageal injury 16 h post injury via a left thoracotomy. Recurrent
lung collapse and pleural effusion was managed with tube thoracostomy and chest physiotherapy.
DISCUSSION: Esophageal perforations occur infrequently and may produce vague symptoms leading to
diagnostic and therapeutic delays. High index of suspicion particularly in penetrating chest trauma fol lowed by relevant investigations may reduce delay. Principles of management include treatment of
contamination, wide local drainage, source control and nutritional support. Source control is achieved
surgically or through endoluminal placement of stents. Surgical options include primary repair, creation
of a controlled fistula by T-tube or esophageal exclusion.
CONCLUSION: Primary repair of traumatic injury to a healthy esophagus is feasible for cases diagnosed
early and without significant mediastinal contamination as in our case. Associated injuries are more likely
in such cases to lead to increased morbidity and prolonged hospital stay and must be handled carefully. |
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