Therapeutic Approach in the Penetrating Cervical Esophageal Trauma

Abstract

Introduction: Cervical esophageal perforations for external trauma are rare injuries associated with a significant morbidity. The primary mechanisms are penetrating trauma for gunshot wounds, accounting for about 80 % of cases, followed by sharp weapon injuries, accounting for 15 % to 20 %.

Objective: To describe the current criteria on the behavior and therapeutic approach to cervical esophageal penetrating trauma.

Methods: A descriptive narrative review was carried out of primary and secondary sources that addressed the subject during the first semester of the year 2021. The selection criteria of the articles to be examined were determined, among others, by the objective of the current review.

Development: The standard diagnosis for these lesions, in the absence of hemodynamic instability, was based on studies such as esophagogram, endoscopy and tomography. Primary repair with or without reinforcement was the most commonly used option, although local conditions and type of lesion in cervical esophagus largely mark the procedure to be performed.

Conclusions: Traumatic cervical esophageal injuries are rare but very morbid. Their treatment depends on the location of the perforation and any concurrent injury. Most cases are amenable to primary repair with flap reinforcement. Other principles of treatment include adequate drainage around the repair, decompression of the esophagus and stomach (by nasogastric tube or gastrostomy tube), as well as distal enteral nutrition (feeding jejunostomy). The surgeon must be incisive in efforts to discover the injury early and manage it appropriately.