Singh Manpreet K, Banihani Shamieh, Singh Anika, Molkara Afshin
School of Medicine, University of California, Riverside, Riverside, CA, USA.
School of Medicine, University of California, Riverside, Riverside, CA, USA.
Int J Surg Case Rep. 2023 Apr;105:108047. doi: 10.1016/j.ijscr.2023.108047. Epub 2023 Mar 24.
Esophageal rupture and perforation are serious complications of blunt abdominal trauma. Early diagnosis and intervention is key for patient survival. Studies have reported that mortality of patients with esophageal perforation can be as high as 20-40 % (Schweigert et al., 2016; Deng et al., 2021 [1, 2]). We present a patient with suspected esophageal perforation after a blunt trauma identified by esophagogastroduodenoscopy (EGD) as the presence of a second gastroesophageal lumen concerning for esophagogastric fistula.
Our patient is a 17-year-old male with no past medical history who was brought in from an outside facility status post electric bike accident. CT imaging from an outside hospital showed concern for possible esophageal rupture. On arrival, he was in no acute distress. Patient underwent a fluoroscopy upper GI series which showed extravasation of fluid outside the lumen, indicating an esophageal injury. Patient was evaluated by Gastroenterology and Cardiothoracic surgery, who agreed on an empiric course of piperacillin/tazobactam and fluconazole for prophylaxis in the setting of suspected esophageal rupture. Patient underwent an esophagram with EGD which demonstrated a 2nd false lumen from 40 to 45 cm. This appeared to be from incomplete avulsion of the submucosal space. No contrast extravasation was seen with the esophagram.
To date, there has been no published case of trauma induced formation of a double lumen esophagus. Our patient presented with no previous history to suggest chronic or congenital double lumen of the esophagus.
When considering esophageal rupture, the possibility of the formation of an esophago-gastric fistula should be considered via external traumatic insult.
食管破裂和穿孔是钝性腹部创伤的严重并发症。早期诊断和干预是患者存活的关键。研究报告称，食管穿孔患者的死亡率可高达20% - 40%（施魏格特等人，2016年；邓等人，2021年[1,2]）。我们报告一例钝性创伤后疑似食管穿孔的患者，经食管胃十二指肠镜检查（EGD）发现存在第二个胃食管腔，疑似食管胃瘘。
我们的患者是一名17岁男性，既往无病史，因电动自行车事故从外部医疗机构转入。外院的CT影像显示可能存在食管破裂。入院时，他没有急性窘迫症状。患者接受了荧光透视上消化道造影，显示管腔外有液体外渗，提示食管损伤。患者接受了胃肠病学和心胸外科的评估，他们一致认为在疑似食管破裂的情况下，经验性使用哌拉西林/他唑巴坦和氟康唑进行预防。患者接受了EGD食管造影，显示在40至45厘米处有第二个假腔。这似乎是由于黏膜下间隙不完全撕脱所致。食管造影未发现造影剂外渗。
迄今为止，尚无创伤诱发双腔食管形成的病例报道。我们的患者既往无病史提示食管慢性或先天性双腔。
在考虑食管破裂时，应通过外部创伤性损伤考虑食管胃瘘形成的可能性。
