Traumatic Esophageal Injury: a 27 Year Experience in a Large Trauma Registry
Cameron Stock, Bruce Simon, Karl F. Uy, Geoffrey Graeber, University of Massachusetts Medical School, Worcester, MA
OBJECTIVE: Traumatic esophageal injury exclusive of iatrogenic or spontaneous rupture is a rare event. We sought to define our experience with 15 patients from a large trauma registry who experienced traumatic esophageal injury.
METHODS: We examined patient records from a single institution, level one trauma registry from 1989-2016 who had a traumatic esophageal injury. Out of 56,346 patients, 15 patients met criteria for inclusion.
RESULTS: The most common injury was an esophageal laceration (6/15) followed by esophageal rupture (4/15) and esophageal hematoma (4/15). There was one patient with a caustic injury to the esophagus. The mechanism of injury was blunt in 9 patients (60%) and penetrating in 5 patients (33%). The average age was 37 [14-68] and the majority were male (11/15). Eighty percent of patients had other associated injuries. There was one patient mortality which occurred on hospital day number one. Seven patients required an operative procedure. Procedures ranged from exploration (4/7) or endoscopy (2/7) to formal surgical repair of the injury (1/7). All patients with penetrating injuries underwent a surgical procedure. Four patients received enteral nutrition (27%) with a surgically placed feeding tube.
CONCLUSIONS: Traumatic esophageal injury is a rare event as confirmed by our experience. The majority of patients have other associated injuries and a large percentage of patients with blunt injuries can be managed non-operatively (78%). The overall mortality of 6.7% was low in this series.