OR^
Manage
Cervical Injury^
Yes
Yes
OR^ (+)
Indications for Thoracic
Neck Immediate Neck
Exploration CTA Periesophageal Esophagoscopy /
Blunt Injury, No
Neck Air / Fluid Esophagography
Iatrogenic,
Spontaneous Chest Indications for
No (-)
Immediate CTA No
Thoracotomy Chest
Manage Other
Yes Injuries
OR^
Yes
Thoracic Stable patient,
Contained perforation NPO, Abx, PPI, Re-Imaging
Injury
No
Thoracoscopic Debridement and
Yes Yes Drainage; Consider Gastrostomy
Stable Patient, Early (<24 hr) Small Consider endoscopic stenting or
and/or Jejunostomy
(<2 cm) Free Perforation clipping if expertise available
No No
Buttress
Yes
Drain
Thoracotomy** Primary Repair
NG Tube
Endoscopy Amenable to
Debridement Primary Repair? Repair Over T-Tube
Gastrostomy Tube
No No Jejunostomy Tube
## If exploring specifically for esophageal injury, left anterior cervical incision is Significant Tissue Esophageal Diversion
preferred; otherwise exploration is on the side of penetrating injury Loss Cervical Esophagostomy
** Anterolateral thoracotomy if patient unstable; Posterolateral if injury is Gastrostomy Tube
localized and patient is stable; Right thoracotomy for upper esophagus; Left Yes Jejunostomy Tube
thoracotomy for lower esophagus
TERIMAKASIH