Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29/3, 8036, Graz, Austria.
Wien Klin Wochenschr. 2024 Oct;136(19-20):575-580. doi: 10.1007/s00508-024-02397-3. Epub 2024 Jul 10.
A 74-year-old male patient was referred with signs of sepsis 5 days after having been diagnosed with a rib fracture following a fall out of bed. Novel hypodensities were visible on thoracic X‑rays and laboratory tests revealed elevated inflammatory parameters. Subsequently performed thoracic computed tomography (CT) scan showed burst fracture of the 3rd thoracic vertebra, posttraumatic esophageal rupture at the same level and mediastinitis. Furthermore, marked degenerative changes of the spinal column (diffuse idiopathic skeletal hyperostosis) were present. The patient underwent emergency thoracotomy and esophagectomy. Gastric pull-up with esophagogastrostomy was postponed for 3 days. After 14 days on the intensive care unit (ICU) and 12 days of i.v. antibiotics, the patient was transferred to the general ward and 7 weeks after trauma the patient was infection-free without difficulties in swallowing. Up to the latest follow-up 41 months following injury, several endoscopic dilations with a bougie due to constrictions at the anastomosis have been performed. Similar to previous cases in the literature, esophageal injury was diagnosed delayed, with the patient already having developed severe complications. This extremely seldom injury should be suspected in young patients following high-energy trauma, but also in older patients after low-energy trauma but known degenerative changes of the vertebral column.
一位 74 岁男性患者因跌倒致肋骨骨折，5 天后出现脓毒症症状被转来。胸部 X 线和实验室检查可见新出现的密度减低影，提示炎症参数升高。随后进行的胸部 CT 扫描显示第 3 胸椎爆裂性骨折，同一水平外伤性食管破裂和纵隔炎。此外，还存在明显的脊柱退行性改变（弥漫特发性骨肥厚）。患者接受了紧急开胸和食管切除术。胃上提和食管胃吻合术推迟了 3 天。在重症监护病房（ICU） 14 天和静脉注射抗生素 12 天后，患者转至普通病房，创伤后 7 周患者无感染且吞咽无困难。截至损伤后最新随访 41 个月，由于吻合口狭窄，已进行了多次内镜扩张和探条扩张。与文献中的先前病例类似，食管损伤被延迟诊断，患者已出现严重并发症。这种极其罕见的损伤应在高能创伤后年轻患者中怀疑，但也应在低能创伤后且已知存在脊柱退行性改变的老年患者中怀疑。
