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Traumatic esophageal injury
The following summarized guidelines for the evaluation and management of traumatic esophageal injury are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2019).
Physical examination: do not rely on physical examination as it is not reliable for early diagnosis of traumatic esophageal injury.
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Upper gastrointestinal endoscopy: perform flexible endoscopy as an adjunct to CT in patients with suspected traumatic esophageal injury.
Indications for non-surgical management
Offer non-surgical management for patients with esophageal perforation if they meet the criteria for non-surgical management:
delay in management of < 24 h
absence of symptoms and signs of sepsis
cervical or thoracic location of the esophageal perforation
contained perforation by surrounding tissues (intramural; minimal peri-esophageal extravasation of contrast material with intra-esophageal drainage; absence of massive pleural contamination)
no preexistent esophageal disease
possibility of close surveillance by expert esophageal team
availability of surgical and radiological skills all day and all night
Offer non-surgical management for patient with traumatic esophageal injury only if intense monitoring in an ICU setting, surgical expertise and interventional radiology skills are available all day and all night.
Surgery: perform immediate surgery in patients with traumatic esophageal injury if they have hemodynamic instability, obvious non-contained extravasation of contrast material and systemic signs of severe sepsis.
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