THROUGH AND THROUGH PENETRATING CERVICAL ESOPHAGEAL INJURY – A CASE REPORT
A 25 year old male presented to emergency department within 2 hours of accidental penetrating injury to neck while handling a machine grinder at the work place.
He had a laceration measuring 3 x 1 cm in Zone 1 of the neck about 3 cm above the suprasternal notch and medial to sternocleidomastoid muscle. (figure 1)
There was saliva coming out from the wounds, which lead to suspicion of esophageal injury. He had minimal subcutaneous emphysema in neck
After giving prophylactic iv antibiotics, within 6 hrs neck exploration was done with an oblique cervical incision along the anterior border of the sternocleidomastoid muscle
Operative finding showed through and through perforation of esophagus (Figure 2).
No airway injury was seen. In view of minimal contamination and early presentation, it was decided to do primary repair.
Posterior layer was repaired with 3-0 polyglactin interrupted sutures.
Ryle’s tube was positioned and anterior layer was approximated with 3-0 polyglactin. Drain was placed. Wound closed.
Feeding jejunostomy was done
IV antibiotics were continued post operatively.
Ryle’s tube was removed on 6th post op day.
Barrium swallow study was done on 9th post op day which showed no leakage. Hence he was started on oral liquids which he tolerated well.
He was discharged after removal of drain and clips.
On follow up patient had no complications and was doing well.