K. Chow1, H. N. Mashbari1, M. Hemdi1, E. Smith-Singares1 1University Of Illinois At Chicago,Division Of Surgical Critical Care,Chicago, IL, USA
Introduction:
Esophageal trauma represents an uncommon but potentially catastrophic injury with a reported overall mortality of up to 20%. The management of iatrogenic and spontaneous perforations have been previously described with well-established guidelines which have been mirrored in the trauma setting. Esophageal leaks are the most feared complication after primary surgical management and present a challenge to salvage. There has been increasing reports in the literature supporting the use of removable covered metal stents to heal esophageal perforations and leaks in the non-trauma setting. We present the largest case series of four patients presenting with external trauma induced esophageal injuries, with failure of initial primary surgical repair with subsequent development of a leak successfully managed with esophageal stenting.
Methods:
A retrospective review of four patients who underwent endoscopically placed indwelling covered metal stents after leakage of primary esophageal repair was performed. Demographic information, hospital stay, additional interventions, complications, imaging studies, ISS scores, and outcomes were collected.
Results:
Our cohort consisted of 4 patients with penetrating injuries to the chest and neck with esophageal injuries (3 thoracic and 1 cervical esophageal injuries) managed with esophageal stenting after leaks were diagnosed following primary repair. Leaks were diagnosed on average post-operative day 9 with stents placed within 3 days after diagnosis. There was complete resolution of their esophageal fistulas with all patients resuming oral intake (averaging 72 days after stent placement). Three patients (75%) required further endoscopic interventions to adjust the stent due to migration or for dilations due to strictures. Mortality was 0%, all patients survived to be discharged from the hospital with average ICU length of stay of 30 days.
Conclusion:
The use of esophageal stenting has progressed over the last few years, with successful management of both post-operative upper gastrointestinal leaks as well as benign, spontaneous, or iatrogenic esophageal perforations. While the mainstay of traumatic esophageal injuries remains surgical exploration, debridement, and repair with perivisceral drainage; our case series illustrates that the use of esophageal stents is an attractive adjunct that can be effective in the management of post-operative leaks after attempted repair of external penetrating traumatic injuries to the esophagus.
