|
Oesophageal Injury
Oesophageal and pharyngeal injuries may be difficult
to diagnose, but the morbidity and mortality of missed
oesophageal injuries is high. Oesophageal injury should
be suspected in all patients with penetrating neck trauma,
and especially where there is a gunshot wound traversing
the midline.
Patients may complain of pain on swallowing (odynophagia)
or haemoptysis/haematemesis. A lateral neck radiograph
should be obtained, which may show prevertebral soft
tissue swelling or subcutaneous emphysema.
The presence of subcutaneous emphysema,
in the absence of a pneumothorax, is an indication for
surgical exploration. Otherwise, further investigation
will be necessary when there is suspicion of a pharyneal
or oesophageal injury. Oesophagoscopy and gastrograffin
swallow are both employed. Each modality alone has a
sensitivity of around 80-90%, while combined they have
a sensitivity of approximatly 95%. With the advent of
new multislice helical CT scanners, the sensitivity
of CT for assessing oesophaegal injury may improve to
a point where CT may become the primary investigation.
However there is not enough evidence to advocate this
approach as yet.
Patients without physical or radiographic
signs of oesophageal injury may be observed in a critical
care area.
|
