In elderly patients, as in the general population, esophageal injury is a rare consequence of trauma. Esophageal injury following penetrating trauma is more common than esophageal injury following blunt trauma. Associated tracheobronchial and vascular injuries are more likely in the setting of penetrating esophageal trauma due to the mechanism of injury and the proximity of these relevant structures. Mechanisms of blunt trauma associated with rapid deceleration may rarely lead to esophageal injury; however, the intrathoracic location of the esophagus is often protective. In a review of all trauma admissions over a 5-year period (2009–2014), penetrating esophageal injury accounted for 0.6% of all admissions. Blunt esophageal injury was even less frequent, accounting for only 0.06% of all admissions (Biffl et al., J Trauma Acute Care Surg 79(6):1089–95). Elderly trauma patients are typically frailer than those in the general population. While they are increasingly predisposed to rib fractures and vertebral fractures, even in the setting of simple mechanical falls, there does not appear to be an increased likelihood of esophageal injury in the elderly population. The anatomic changes and altered physiology associated with aging may increase the potential for iatrogenic injury, however. Musculoskeletal derangements such as kyphosis, bone spurs, and cervical and thoracic lumbar spine degeneration can all lead to impingement or altered course of the esophagus. Similarly, the structure and function of the esophagus can potentially be altered with aging, leading to diverticuli, stricturing, tortuosity, and hiatal hernia, all of which may potentiate iatrogenic injury.
KeywordsEsophageal injury Penetrating esophageal injury Blunt esophageal injury Pneumomediastinum Esophageal stent
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