International journal of emergency medicine · 2026
War-related penetrating cervicothoracic trauma managed in a resource-limited hospital in Syria: a case series.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Alkhayer Issam, Aldakak Mohammad Alaa, Abbas Youssef
Аннотация
BACKGROUND: Penetrating cervicothoracic trauma in war is time-critical because airway, major vascular, and aerodigestive injuries may coexist, rapidly causing hypoxemia, exsanguination, or pleural/mediastinal contamination. CT can support triage and operative planning in transportable patients, while bronchoscopy, vascular imaging, and contrast/endoscopic esophageal studies may further refine assessment when available.
CASE PRESENTATION: We reviewed consecutive war-related penetrating neck/upper-chest injuries treated at a military hospital in Syria between 2015 and 2017. Inclusion required intraoperative confirmation of tracheal, major thoracic vascular, or esophageal injury. Three male patients underwent emergency surgery. Case 1 presented with profound hypoxemia, extensive subcutaneous emphysema, pneumomediastinum, and persistent massive air leak after drainage. CT suggested tracheal disruption; right thoracotomy revealed a longitudinal tracheal laceration with tissue loss approximately 3 cm below the cricoid, extending 2 cm. Case 2 arrived in profound shock with absent left upper-limb pulses and massive hemothorax; trap-door exploration identified complete left subclavian artery transection. Case 3 had CT evidence of a retained projectile near the mid-esophagus and right hemopneumothorax; food-like pleural drainage prompted thoracotomy, confirming a 4-cm mid-esophageal tear.
CASE DISCUSSION: Management was physiology-driven. The tracheal injury was repaired with interrupted absorbable sutures and intercostal muscle-flap buttress. The subclavian artery was reconstructed with an interposition graft, restoring distal pulses. The esophageal injury underwent primary repair with broad-spectrum antimicrobials.
CONCLUSION: In austere conflict settings, CT-informed triage plus decisive operative management can be lifesaving, but imaging should not delay exploration when hard clinical signs persist.
CASE PRESENTATION: We reviewed consecutive war-related penetrating neck/upper-chest injuries treated at a military hospital in Syria between 2015 and 2017. Inclusion required intraoperative confirmation of tracheal, major thoracic vascular, or esophageal injury. Three male patients underwent emergency surgery. Case 1 presented with profound hypoxemia, extensive subcutaneous emphysema, pneumomediastinum, and persistent massive air leak after drainage. CT suggested tracheal disruption; right thoracotomy revealed a longitudinal tracheal laceration with tissue loss approximately 3 cm below the cricoid, extending 2 cm. Case 2 arrived in profound shock with absent left upper-limb pulses and massive hemothorax; trap-door exploration identified complete left subclavian artery transection. Case 3 had CT evidence of a retained projectile near the mid-esophagus and right hemopneumothorax; food-like pleural drainage prompted thoracotomy, confirming a 4-cm mid-esophageal tear.
CASE DISCUSSION: Management was physiology-driven. The tracheal injury was repaired with interrupted absorbable sutures and intercostal muscle-flap buttress. The subclavian artery was reconstructed with an interposition graft, restoring distal pulses. The esophageal injury underwent primary repair with broad-spectrum antimicrobials.
CONCLUSION: In austere conflict settings, CT-informed triage plus decisive operative management can be lifesaving, but imaging should not delay exploration when hard clinical signs persist.