Diagnosis of penetrating injuries of the pharynx and esophagus in the severely injured patient.
BACKGROUND
Diagnosis of penetrating pharyngeal and esophageal injuries are difficult when the patient has severe facial injuries, is obese or intubated, and hemodynamically unstable. Radiologic aids may be either unsuitable or unreliable. Videoendoscopy, preferably by the trauma surgeon, affords direct visualization at the bedside and is timely and expeditious.


METHODS
Patients included in the study had penetrating injuries to the face/neck or torso. Evaluation began with careful assessment of the trajectory, followed by videoendoscopy and a contrast study. Data collected included the accuracy of diagnosis (compared with anatomic findings), time required to perform the studies, and complications resulting from both tests and repair.


RESULTS
Thirty-three patients were included in the study. Contrast study detected all esophageal injuries, but failed to detect any hypopharyngeal injuries particularly in the intubated patients. Videoendoscopy detected all injuries, hypopharyngeal and esophageal in intubated and nonintubated patients.


CONCLUSIONS
Radiologic studies should not be used for pharyngeal injuries. Although radiologic studies accurately diagnosed penetrating injuries of the esophagus, it is not as expeditious as videoendoscopy performed by the trauma surgeon. Videoendoscopy should be part of the trauma surgeons' armamentarium.
Ahmed
Naveed
N
Department of Surgery, Huron Hospital, Cleveland Clinic, Cleveland, Ohio, USA. nahmed@cchseast.org
Massier
Christian
C
Tassie
James
J
Whalen
James
J
Chung
Raphael
R
D000328:Adult; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019838:Neck Injuries / Q000175:diagnosis* / Q000601:surgery; D010614:Pharynx / Q000293:injuries*; D011379:Prognosis; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult