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Case #3:Through And Through Penetrating Cervical Esophageal Injury

THROUGH AND THROUGH PENETRATING CERVICAL ESOPHAGEAL INJURY – A CASE REPORT 

  • A 25 year old male presented to emergency department within 2 hours of accidental penetrating injury to neck while handling a machine grinder at the work place.
  • He had a laceration measuring 3 x 1 cm in Zone 1 of the neck about 3 cm above the suprasternal notch and medial to sternocleidomastoid muscle. (figure 1)
  • There was saliva coming out from the wounds, which lead to suspicion of esophageal injury. He had minimal subcutaneous emphysema in neck
  • After giving prophylactic iv antibiotics, within 6 hrs neck exploration was done with an oblique cervical incision along the anterior border of the sternocleidomastoid muscle.
  • Operative finding showed through and through perforation of esophagus (Figure 2).
  • No airway injury was seen. In view of minimal contamination and early presentation, it was decided to do primary repair.
  • Posterior layer was repaired with 3-0 polyglactin interrupted sutures.
  • Ryle’s tube was positioned and anterior layer was approximated with 3-0 polyglactin. Drain was placed. Wound closed.
  • Feeding jejunostomy was done
  • He was started and maintained on FJ feeds since 2ndpost op day
  • IV antibiotics were continued post operatively.
  • Ryle’s tube was removed on 6th post op day.
  • Barrium swallow study was done on 9th post op day which showed no leakage. Hence he was started on oral liquids which he tolerated well.
  • He was discharged after removal of drain and clips.
  •  On follow up patient had no complications and was doing well.
Figure.1

Figure.1

Figure 2

Figure.2