Grabill Nathaniel, Louis Mena, Redenius Nicole, Cawthon Mariah, Gibson Brian
Northeast Georgia Medical Center, General Surgery Department, Gainesville, GA 30501, USA.
North Alabama Medical Center, General Surgery Department, Florence, AL 35630, USA.
Trauma Case Rep. 2024 Nov 26;54:101117. doi: 10.1016/j.tcr.2024.101117. eCollection 2024 Dec.
Blunt esophageal injury is an exceptionally rare condition, with complete esophageal avulsion being almost unprecedented in adults. This case study details the clinical presentation, surgical management, and postoperative course of a 50-year-old male who sustained a complete esophageal avulsion following blunt abdominal trauma. The patient presented with increasing abdominal pain two hours after falling while stepping up onto a high truck step, striking his upper abdomen on the step. CT imaging revealed pneumomediastinum and pneumoperitoneum. Emergent exploratory laparotomy and thoracotomy uncovered a complete avulsion of the esophagus from the gastroesophageal junction. The surgical repair involved resection of the damaged esophagus and gastric cardia, an esophagogastric anastomosis using a 25 mm EEA stapler, and the creation of an omental pedicle flap. Postoperative management included antibiotic prophylaxis and intensive care monitoring. Blunt traumatic esophageal injuries, although rare, pose significant diagnostic and therapeutic challenges due to their potential for severe complications such as mediastinitis, sepsis, and multi-organ failure. Prompt recognition of the injury through imaging and clinical assessment is essential for initiating timely surgical intervention. The surgical approach must be meticulously planned to address the complexity of the injury, often requiring a combination of thoracic and abdominal procedures. Additionally, the role of a multidisciplinary team, including surgeons, intensivists, and gastroenterologists, is crucial in managing both the immediate and long-term aspects of patient care. This case emphasizes the necessity for a comprehensive and coordinated treatment strategy to optimize outcomes. It highlights the importance of continued research and education in managing such rare and severe injuries.
钝性食管损伤是一种极为罕见的病症，成人食管完全撕脱几乎前所未闻。本病例研究详细介绍了一名50岁男性在钝性腹部创伤后发生食管完全撕脱的临床表现、手术治疗及术后病程。患者在踏上高高的卡车台阶时摔倒，上腹部撞到台阶，两小时后出现腹痛加剧。CT影像显示纵隔气肿和气腹。急诊剖腹探查术和开胸手术发现食管自胃食管交界处完全撕脱。手术修复包括切除受损的食管和胃贲门，使用25毫米端端吻合器进行食管胃吻合，并制作带蒂网膜瓣。术后管理包括抗生素预防和重症监护监测。钝性创伤性食管损伤虽然罕见，但由于其可能引发纵隔炎、败血症和多器官功能衰竭等严重并发症，在诊断和治疗方面面临重大挑战。通过影像学和临床评估及时识别损伤对于及时启动手术干预至关重要。必须精心规划手术方案以应对损伤的复杂性，通常需要胸腹部联合手术。此外，包括外科医生、重症监护医生和胃肠病学家在内的多学科团队在管理患者护理的近期和长期方面都起着关键作用。本病例强调了采取全面协调的治疗策略以优化治疗效果的必要性。它凸显了在处理此类罕见且严重损伤方面持续开展研究和教育的重要性。
