Gill Roger Christopher, Mannan Fatima, Bawa Amber, Zafar Hasnain
Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
BMJ Case Rep. 2015 May 15;2015:bcr2014208918. doi: 10.1136/bcr-2014-208918.
Oesophageal injury due to blunt trauma is extremely rare, and when it presents it carries a very high mortality. Time is of essence and if not promptly recognised these injuries could have devastating consequences. We report a case emphasising the importance of oesophagoscopy in diagnosing oesophageal injuries. A young man presented to our emergency ward as an unwitnessed road traffic accident after receiving first aid from a secondary care facility. At presentation, he was haemodynamically stable with decreased power in lower limbs, and with severe neck and back pain. There was high suspicion of spinal injury, which was later evident on clinical and on radiological findings. A CT scan revealed oesophageal injury, indicated by contrast extravasation, which was convincing enough to proceed without endoscopy. Surprisingly, the apparently convincing injury picked up on CT scan marked by contrast extravasation turned out to be an artefact, which led to a negative surgical exploration.
钝性创伤导致的食管损伤极为罕见，一旦出现，死亡率极高。时间至关重要，如果不能及时识别这些损伤，可能会造成灾难性后果。我们报告一例病例，强调食管镜检查在诊断食管损伤中的重要性。一名年轻男子在二级护理机构接受急救后，作为一起无人目睹的道路交通事故患者被送往我们的急诊病房。就诊时，他血流动力学稳定，但下肢肌力下降，伴有严重的颈部和背部疼痛。高度怀疑有脊柱损伤，后来临床和影像学检查结果证实了这一点。CT扫描显示食管损伤，表现为造影剂外渗，这足以令人信服，无需进行内镜检查即可继续治疗。令人惊讶的是，CT扫描上显示的明显由造影剂外渗标记的令人信服的损伤结果却是一种假象，这导致了手术探查结果为阴性。
