Journal of Indian Association of Pediatric Surgeons
Journal of Indian Association of Pediatric Surgeons
                                                   Official journal of the Indian Association of Pediatric Surgeons                           
Year : 2006  |  Volume : 11  |  Issue : 2  |  Page : 101--102

Intrathoracic esophageal rupture following blunt trauma chest in a ten months old girl


Rajendra K Ghritlaharey, Ajay K Jain, Gaurav Gupta, Anand Singh Kushwaha 
 Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal - 462 001, MP, India

Correspondence Address:
Rajendra K Ghritlaharey
Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal - 462 001, MP
India

Abstract

A 10 months old girl child was admitted on June 05 2005, with a history of blunt injury of chest and respiratory distress for 2 days. Chest skiagram showed effusion on right side of chest, with shift of mediastinum to opposite side. Right intercostal chest drainage was done for pyopneumothorax. Rupture of esophagus was suspected, when the chest drain showed milk. Water-soluble contrast study confirmed rupture of thoracic esophagus. Conservative management was successful in the form of intercostal chest drainage, broad-spectrum antibiotics, nasogastric feeding, parenteral nutrition, etc. A repeat contrast study showed no stricture or leak. At a follow up of 3 months, she is doing well. To the best of our knowledge, this is the youngest patient with blunt injury of chest, leading to intrathoracic esophageal rupture.



How to cite this article:
Ghritlaharey RK, Jain AK, Gupta G, Kushwaha AS. Intrathoracic esophageal rupture following blunt trauma chest in a ten months old girl.J Indian Assoc Pediatr Surg 2006;11:101-102


How to cite this URL:
Ghritlaharey RK, Jain AK, Gupta G, Kushwaha AS. Intrathoracic esophageal rupture following blunt trauma chest in a ten months old girl. J Indian Assoc Pediatr Surg [serial online] 2006 [cited 2022 May 22 ];11:101-102
Available from: https://www.jiaps.com/text.asp?2006/11/2/101/25935


Full Text

The most common causes of esophageal injuries in children, are ingestion of caustic liquids and penetrating trauma, which includes iatrogenic instrumentations. External blunt trauma to chest can also cause esophageal injury, though rarely.[1],[2] The incidence of esophageal perforation due to all blunt injury chest in children is et al saw no intrathoracic esophageal perforations in a series of 340 patients, hospitalised with blunt chest trauma. Beal et al . reviewed all esophageal perforations (cervical, thoracic and abdominal) from blunt trauma, noting 96 published cases (between 1900-1988) and they estimated the overall incidence of blunt esophageal injuries at 0.001%.[2] Balci et al . reviewed 137 cases of blunt thoracic trauma in children (age 1-16 yrs) and found only one case of esophageal rupture.[3]

The pathological mechanism of esophageal injuries is believed to be either due to a sudden rise in intraesophageal pressure caused by expulsion of gas from stomach through the gastroesophageal junction against a closed glottis, or due to compression of esophagus between the sternum and vertebrae. Esophageal perforation can cause chest pain, dyspnea, fever, tachycardia and subcutaneous emphysema in neck.[4]

When an esophageal injury is clinically suspected, a diagnostic investigation is warranted. But the elaborate diagnostic study should always be differed, till the patient's condition is stabilized. Diagnosis is confirmed by using contrast esophagogram or endoscopy or both. A negative study does not completely exclude esophageal injury, as false negative rate may be as high as 40% for contrast studies and 30% for endoscopy. Focal extra luminal collection at the site of esophageal tear, haematoma of the mediastinum or esophagus wall and occasionally a tract at the site of the tear, can be identified on CT scan of chest, besides evaluating the associated injuries to the other intra thoracic structures.

Management of patients with esophageal perforation remains controversial. Numerous options are available for management of esophageal injuries, including non-operative treatment, primary repair, diversions, etc. Primary closure within 24 hours is most effective method of treating esophageal perforation. Surgical management must be individualized according to the size of the defect, degree of inflammation, contamination and the overall condition of patient. Patients can be successfully treated non-operatively, if presented after 48 hours of esophageal perforation. [4],[5],[6],[7],[8]

Our patient presented to us, 48 hours after injury and diagnosis of esophageal rupture was established on 4th day. Due to delay in diagnosis, we opted for conservative management and were able to manage her successfully. We reviewed recent data available on the website and were not able to find any case report, etc, related to a blunt injury chest leading to esophageal rupture in an infant.

References

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3Balci AE, Kazez A, Eren S, Ayan E, Ozalp K, Eren MN. Blunt thoracic trauma in children: review of 137 cases. Eur J Cardiothorac Surg 2004;26:387-92.
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