Clinical Challenges in Trauma Surgery: Traumatic Esophageal Injury

The dreaded esophageal injury.  Do you still have nightmares about mock oral board scenarios torturing you with the ins and outs of how to manage traumatic esophageal injury?  Think you remember all the nuances?  Whether you do or you don’t, this episode should serve as a good refresher for all levels while offering some pearls for management of this tricky scenario.Hosts:- Michael Cobler-Lichter, MD, PGY4/R2:University of Miami/Jackson Memorial Hospital/Ryder Trauma Center@mdcobler (X/twitter)- Dylan Tanzer, MD, 2nd-year Trauma/Surgical Critical Care FellowUniversity of Miami/Jackson Memorial Hospital/Ryder Trauma Center- Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending:Loma Linda UniversityRecent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship- Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery, 5 years in practiceUniversity of Miami/Jackson Memorial Hospital/Ryder Trauma Center@jpmeizoso (twitter)Learning Objectives:- Describe the diagnostic workup of a suspected traumatic esophageal injury- Identify when someone with suspected esophageal injury needs immediate surgical management- Describe appropriate surgical techniques for repair of both cervical and thoracic esophageal injuriesQuick Hits:1.     Don’t forget the primary survey.  Unstable patients should be in the OR, as should patients with hard signs of vascular or aerodigestive injury2.     If there is concern for esophageal injury but no immediate indication for the OR, this should be further investigated with CTA of the affected area.  Clinical exam has poor sensitivity.3.     The esophagus should be primarily repaired if the defect is able to come together without tension after debridement.  Don’t forget a well-vascularized buttress4.     If you cannot perform a primary repair, your procedure of choice should be lateral esophagostomy with feeding jejunostomy and gastrostomy for decompression.  Repair over T-tube can be considered for injuries with small amounts of tissue lossReferences1.     Biffl WL, Moore EE, Feliciano DV, Albrecht RA, Croce M, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma: Diagnosis and Management of Esophageal Injuries. J Trauma Acute Care Surg 2015;79(6):1089-95.https://pubmed.ncbi.nlm.nih.gov/26680145/2.     Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, et al. Western Trauma Association Critical Decisions in Trauma: Penetrating Neck Trauma. J Trauma Acute Care Surg 2013;75(6):936-40.https://pubmed.ncbi.nlm.nih.gov/24256663/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen