African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2016
Conservative management of gunshot oesophageal injuries: A report of two consecutive exceptional cases.
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Virdis Francesco, Chowdhury Sharfuddin, Nicol Andrew John, Navsaria Pradeep Harkison
Аннотация
INTRODUCTION: Oesophageal trauma carries high mortality and morbidity. For penetrating intrathoracic oesophageal injury, surgical repair has been the standard for decades to avoid its devastating consequences.
CASE REPORT: Both patients presented with a thoracoabdominal gunshot wound and retained intraabdominal missile. Although there were no visible signs of perforation on oesophagoscopy or contrast swallow, the presence of an intraluminal bullet highly suggested a thoracic oesophageal injury.
DISCUSSION: Non-operative management of intrathoracic oesophageal perforation is controversial. Small perforations or contained leaks diagnosed within 24-48 h in a stable patient with no mediastinitis or empyema can be managed non-operatively with antibiotics and nasogastric feeds. These two case reports support the notion of selective non-operative management of asymptomatic patients with penetrating injury to the oesophagus.
CASE REPORT: Both patients presented with a thoracoabdominal gunshot wound and retained intraabdominal missile. Although there were no visible signs of perforation on oesophagoscopy or contrast swallow, the presence of an intraluminal bullet highly suggested a thoracic oesophageal injury.
DISCUSSION: Non-operative management of intrathoracic oesophageal perforation is controversial. Small perforations or contained leaks diagnosed within 24-48 h in a stable patient with no mediastinitis or empyema can be managed non-operatively with antibiotics and nasogastric feeds. These two case reports support the notion of selective non-operative management of asymptomatic patients with penetrating injury to the oesophagus.