Tugas Persentasi Ruptur Esofagus
Tugas Persentasi Ruptur Esofagus
44-year-old female
with nondisplaced
medial tibial
plateau fracture.
AP of the right
knee
demonstrates an
oblique fracture
(arrow) involving
the medial aspect
of the lateral tibial
plateau and
extending into the
medial plateau
77-year-old man with esophageal rupture. CT of the abdomen
and pelvis with oral and intravenous contrast. Axial (A) CT
image at the level of the aortic arch shows a dilated, air-and-
fluid-filled thoracic esophagus (arrow). Axial (B) and coronal
CT images show extraluminal contrast and air (large arrows)
extending to the left of the distal esophagus (e). Also note
associated bilateral pleural fluid (B, pf) and overlying left-lung
base atelectasis (B, arrowheads).
Fig 1- Diagnostic Evaluation for Esophageal Injury
OR^ No
WTA Penetrating Manage Other
Neck Neck Trauma Injuries
Periesophageal
Algorithm CTA Air / Fluid
Penetrating Neck
Injury
Chest Potential Yes
Yes
Transmediastinal Stable?
CTA
Trajectory Chest Hypopharynx Observe#
No
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 (-)
Thoracotomy Chest No
Manage Other
Yes Injuries
OR^
No Yes
Yes Thoracoscopic Debridement and
Drainage; Consider Gastrostomy
Stable Patient, Early (<24 hr) Consider endoscopic stenting or
and/or Jejunostomy
Small (<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
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