title: Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis.
abstract: The case of an upper oesophageal perforation as a concomitant injury of an isolated fracture of the upper thoracic spine without neurological compromise has not been described so far. A Case report and review of the literature is presented here. Concomitant oesophageal perforations carry a high risk of being missed initially. CT alone can visualize the subtle indirect signs like peri-oesophageal air. The literature revealed that only peri-oesophageal air might be a valid indicator of oesophageal injury. There are no systematic data on thoracic spine fractures with concomitant oesophageal perforations. Mediastinitis secondary to oesophageal perforation might be treated conservatively with endoscopic stent placement rather than surgically. As the radiological signs of concomitant soft tissue injury, like oesophageal perforations, in fractures of the upper thoracic spine are subtle and easily missed initially only anticipation of concomitant injuries by the treating physician based on the trauma mechanism ensures a timely diagnosis.
authors.affiliation: Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimerstrasse 200, Cologne, Germany, T.Tjardes@bdc.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Tjardes
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaizadeh
authors.forename: Eva
authors.initials: E
authors.lastname: Steinhausen
authors.forename: Bernd
authors.initials: B
authors.lastname: Krakamp
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
mesh_terms: D000063:Accidents, Traffic; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000628:therapy*; D008875:Middle Aged; D012421:Rupture / Q000150:complications / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications* / Q000601:surgery; D015607:Stents; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents