Distal thoracic oesophageal perforation secondary to blunt trauma: case report.
BACKGROUND
Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries.


METHODS
We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death.


CONCLUSIONS
Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.
Strauss
Dirk C
DC
Department of General Surgery, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. dirkcstrauss@yahoo.co.uk
Tandon
Ruchi
R
Mason
Robert C
RC