Esophageal injury

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Evaluation

Mediastinal air adjacent to the aorta and tracking cephalad adjacent to the left common carotid artery.

Gastrografin esophagram showing a leak into the left thoracic cavity.

Perforation of the esophagus seen on swallow study.

• Initial study should be esophagogram with water-soluble contrast
  • If negative or ambiguous follow with barium contrast or flexible esophagoscopy

Management

• Volume resuscitation
• Broad-spectrum IV antibiotics
• Emergent surgical consultation
• NPO

Disposition

• Admission
• Typically goes to the OR for exploration

See Also

• Thoracic Trauma
• Esophageal perforation