Esophageal Injury

Chapter

Abstract

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.

Keywords

Esophageal injury Penetrating esophageal injury Blunt esophageal injury Pneumomediastinum Esophageal stent 

References

  1. 1.
    Dissanaike S, Shalhub S, Jurkovich GJ. The evaluation of pneumomediastinum in blunt trauma patients. J Trauma. 2008;65(6):1340–5. http://www.ncbi.nlm.nih.gov/pubmed/19077624 CrossRefPubMedGoogle Scholar
  2. 2.
    Brinster CJ, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475–83. http://www.annalsthoracicsurgery.org/article/S0003-4975(03)01708-9/pdf CrossRefPubMedGoogle Scholar
  3. 3.
    Keogh IJ, Rowley H, Russell J. Critical airway compromise caused by neck haematoma. Clin Otolaryngol Allied Sci. 2002;27(4):244–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Biffl WL, et al. Western Trauma Association Critical Decisions in Trauma: diagnosis and management of esophageal injuries. J Trauma Acute Care Surg. 2015;79(6):1089–95. http://journals.lww.com/jtrauma/Citation/2015/12000/Western_Trauma_Association_Critical_Decisions_in.31.aspx CrossRefPubMedGoogle Scholar
  5. 5.
    Rathlev NK, et al. Evaluation and management of neck trauma. Emerg Med Clin North Am. 2007;25(3):679–94. http://www.emergpa.net/wp/wp-content/uploads/2012/02/Emerg-Med-Clin-N-Am-2007-Neck-Injuries.pdf CrossRefPubMedGoogle Scholar
  6. 6.
    Fadoo F, et al. Helical CT eosphagography for evaluation of suspected esophageal perforation or rupture. AJR Am J Roentgenol. 2004;182(5):1177–9. http://www.ajronline.org/doi/pdf/10.2214/ajr.182.5.1821177 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mathew A. Van Deusen
    • 1
  • Mark Crye
    • 1
  • Jonathan Levy
    • 2
  1. 1.Department of Cardiovascular and Thoracic SurgeryAllegheny Health NetworkPittsburghUSA
  2. 2.Department of General SurgeryAllegheny Health NetworkPittsburghUSA

Personalised recommendations