Intrathoracic esophageal rupture distal to the carina after blunt chest trauma: Case-report.
BACKGROUND
Esophageal rupture caused by blunt chest trauma is a very rare entity, with an incidence of 0.001%. Eighty two percent of the esophageal perforation secondary to blunt chest trauma occur above the level of the carina, with the lowest reported incidence in the intrathoracic region distal to the carina.


METHODS
We report on the case of a 48-year-old Hispanic male with intrathoracic esophageal rupture. Exploration revealed a right lateral, mid esophageal, longitudinal 1.5cm perforation. The defect was repaired using a double-layered primary closure reinforced with an intercostal muscle flap. The patient tolerated the procedure and the recovery was complicated by a pneumonic process which was treated accordingly. No leakage was found.


CONCLUSIONS
A five-year retrospective review (2009-2013) at our institution identified 5586 trauma cases with only one case with esophageal rupture. This represents a 0.0002% of incidence of blunt esophageal rupture. This estimate is consistent with what has been previously reported in the medical literature. Our case represents a uniquely rare presentation of traumatic esophageal rupture due to the underline mechanism of injury and its anatomical location. A high index of suspicion and early intervention are critical in assuring a favorable outcome.


CONCLUSIONS
Diagnosis and surgical intervention with primary repair completed in the first twenty-four hours after presentation is fundamental to achieve a good outcome after esophageal rupture.
Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States.
Alex
A
Cedeño
Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States.
Karla
K
Echeverría
Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States.
Jan
J
Vázquez
Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States.
Aura
A
Delgado
Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States. Electronic address: pablorodriguez@gmail.com.
Pablo
P
Rodríguez-Ortiz
Blunt esophageal perforation; Esophageal injury/perforation; Esophagus; Trauma