Blunt trauma-induced complete esophageal avulsion: A case report on surgical intervention and clinical insights

Abstract

Blunt esophageal injury is an exceptionally rare condition, with complete esophageal avulsion being almost unprecedented in adults. This case study details the clinical presentation, surgical management, and postoperative course of a 50-year-old male who sustained a complete esophageal avulsion following blunt abdominal trauma. The patient presented with increasing abdominal pain two hours after falling while stepping up onto a high truck step, striking his upper abdomen on the step. CT imaging revealed pneumomediastinum and pneumoperitoneum. Emergent exploratory laparotomy and thoracotomy uncovered a complete avulsion of the esophagus from the gastroesophageal junction. The surgical repair involved resection of the damaged esophagus and gastric cardia, an esophagogastric anastomosis using a 25 mm EEA stapler, and the creation of an omental pedicle flap. Postoperative management included antibiotic prophylaxis and intensive care monitoring. Blunt traumatic esophageal injuries, although rare, pose significant diagnostic and therapeutic challenges due to their potential for severe complications such as mediastinitis, sepsis, and multi-organ failure. Prompt recognition of the injury through imaging and clinical assessment is essential for initiating timely surgical intervention. The surgical approach must be meticulously planned to address the complexity of the injury, often requiring a combination of thoracic and abdominal procedures. Additionally, the role of a multidisciplinary team, including surgeons, intensivists, and gastroenterologists, is crucial in managing both the immediate and long-term aspects of patient care. This case emphasizes the necessity for a comprehensive and coordinated treatment strategy to optimize outcomes. It highlights the importance of continued research and education in managing such rare and severe injuries.

Keywords: Blunt trauma; Esophageal avulsion; Esophageal injury; Gastroesophageal junction; Gastroesophageal reflux; Postoperative complications; Surgical repair.

Fig. 1

CT Chest Abdomen Pelvis with contrast (sagittal view) showing pneumomediastinum and pneumoperitoneum concerning for an esophageal injury given the preponderance of gas behind the esophagus near the GE junction (red box). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

CT Chest Abdomen Pelvis with contrast (axial view) showing pneumoperitoneum with gas along the esophagus near the GE junction (red box). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Barium swallow imaging demonstrates mild distal esophageal narrowing just above the lower esophageal sphincter. Despite the narrowing, there is no restriction in the barium flow, indicating preserved esophageal patency (highlighted in red box). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 4

Esophagogastroduodenoscopy (EGD) photo (antegrade view) displaying erosive esophagitis with exudates at the anastomosis site, along with visible surgical staples.

Fig. 5

Esophagogastroduodenoscopy photo (retroflex view) showing the esophagogastric anastomosis that is clearly larger than a normal anatomic esophagogastric junction.