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• W2912852119 abstract "We report a case of a patient with esophageal rupture (ER) from blunt trauma treated successfully with transesophageal mediastinal drainage (TMD) for a persistent defect post-surgical repair. There are very few cases describing this technique and we hope to provide guidance into the multidisciplinary management of this complex diagnosis. A 43-year-old male was found to have pneumomediastinum on CXR after a motor vehicle accident. No significant bony or intra-abdominal injuries were noted. Despite bilateral tube thoracostomies he had worsening respiratory status and subcutaneous emphysema. An esophagram (EG) revealed an intrathoracic ER with extensive contrast extravasation (Figure1). In the operating room; a flexible bronchoscopy was unremarkable but an esophagogastroduodenoscopy (EGD) confirmed a 5cm transmural linear rupture of the distal esophagus extending to just above the z-line. A left muscle-sparing thoracotomy followed by a myotomy and intercostal muscle flap was performed to close the defect (Figure 2). He tolerated the procedure well, and was extubated on postoperative day (POD) #1. On POD #5 new leukocytosis and increasing oxygen requirement were noted; an esophagram followed by a chest CT were performed. Together, these confirmed a small, contained esophageal leak within the mediastinum, not accessible by percutaneous drainage. Gastroenterology was consulted; the EGD revealed a residual 1-cm defect at the superior aspect of the initial 5cm ER. A nasogastric tube (NGT) was guided fluoroscopically through the defect to the most dependent point of the mediastinal cavity for drainage followed by placement of a nasoduodenal tube (NDT) for feeding. Within a week profound clinical improvement was noted and the NGT was eventually removed. An esophagram prior to discharge demonstrated a small residual, nondependent, cavity; that drained immediately back into the esophagus. A follow-up esophagram one week after discharge revealed no extravasation and normal mucosa. The NDT was removed and he was gradually advanced to a regular diet without dysphagia (Figure 3). ER due to blunt trauma is rare, and likely under-diagnosed. It is associated with high rates of morbidity and mortality. It is part of the “overlooked six” conditions that include traumatic rupture of the aorta, rupture of the diaphragm, bronchial tree injury, lung contusion, blunt heart injury. Prompt recognition of the clinical signs and symptoms are key in the diagnosis and management of this uncommon but potentially fatal injury. In this case, delayed treatment with a suboptimal single layer mucosal repair buttressed with an intercostal muscle flap, followed by TMD enabled us to preserve the integrity his native esophagus.Figure: Intrathoracic Esophageal Rupture with Extensive Contrast Extravasation.Figure: Left Muscle Sparing Thoracotomy with Myotomy and Intercostal Muscle Flap Repair.Figure: Successful Treatment and Closure of the Esophageal Rupture with Transesophageal Mediastinal Drainage." @default.
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• W2912852119 date "2017-10-01" @default.
• W2912852119 modified "2023-09-25" @default.
• W2912852119 title "Endoscopic Transesophageal Mediastinal Drainage for a Persistent Esophageal Leak Despite Surgical Repair" @default.
• W2912852119 doi "https://doi.org/10.14309/00000434-201710001-01660" @default.
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