Canarelli J P, Degroote D, Bernard F, Krim G, Lenaerts C
Chir Pediatr. 1983;24(2):133-6.
Presenting symptoms in an 8-year-old child, subjected to high pressure in the upper respiratory and digestive tracts following bursting of a truck inner tube, were initially only pleuropulmonary in nature. A secondary diagnosis of rupture of the thoracic esophagus was established by radiological follow-through examination using a water soluble medium. The presence of an esophagopleural fistula led to repair of the esophageal tear on the 5th day. Operation involved wide mediastinal and thoracic drainage, protection of the esophageal suture by a minimal pharyngostomy, and the performance of an evacuation gastrostomy and an alimentation jejunostomy. Bipolar esophageal exclusion can be avoided by the use of this technique. When confronted with closed thoracic injuries due to high pressures exerted on the upper respiratory and digestive tracts, radiological examination of the esophagus employing water-soluble media should be conducted, therefore, to enable early diagnosis of any esophageal rupture. Furthermore, from the therapeutic point of view, even after secondary discovery of an esophageal tear, suturing is not contraindicated by the direct approach as long as protection is provided by minimal pharyngostomy and a gastrostomy, this avoiding the need for bipolar exclusion.
一名8岁儿童因卡车内胎爆裂致使上呼吸道和消化道受到高压，最初的症状仅表现为胸膜肺部症状。通过使用水溶性介质进行放射学钡餐检查确诊为胸段食管破裂。食管胸膜瘘的存在促使在第5天对食管撕裂处进行修复。手术包括广泛的纵隔和胸腔引流，通过最小限度的咽造口术保护食管缝合处，并进行胃造口减压和空肠造口营养。采用该技术可避免双极食管闭锁。因此，当面对因上呼吸道和消化道受到高压导致的闭合性胸部损伤时，应进行使用水溶性介质的食管放射学检查，以便早期诊断食管破裂。此外，从治疗角度来看，即使在食管撕裂被再次发现后，只要通过最小限度的咽造口术和胃造口术提供保护，直接缝合并非禁忌，从而避免了双极闭锁的需要。
