Surgical tactics of iatrogenic esophageal injuries caused by medical and diagnostic interventions

The aim of this study was to investigate reasons for iatrogenic esophagus injuries caused by medical and diagnostic interventions and to estimate the results of the treatment depending on their type, localization and the time interval from trauma.

Material and method. During last 30 years 90 patients with traumatic injuries of the esophagus were treated, among them - 36 with iatrogenic esophagus injuries due to medical and diagnostic interventions (40%). Most cases were from perforation after boogie of stricture (25) and cardiospasm (2), others - from stenting (6), upper endoscopy (3) and gastric probe (1).

Results. Conservative treatment was successful in two cases with blunt injury not longer than 2,5sm. Esophageal stenting was made in 3 cases. The attempt of clipping the esophageal defect was unsuccessful twice. The vacuum system was installed in one case. Esophageal trauma patients were more likely to require surgery (32, 86,7%) Ten patients underwent suturing of the wound. In the case of perforation the esophagus, narrowed due to stricture, the subtotal resection with gastroplasty through posterior mediastinum was made (7). At late receipt of 9 patients with purulent complications the treatment was limited to drainage of the mediastinum. Complications have developed in 8 cases: insolvency of sutures (3), esophageal-tracheal fistula (2), arrosive bleeding (2), pancreatonecrosis (1). The mortality was 34,2% (13) because of purulent complications (7), depletion (3) and bleeding (3).

Conclusion. The choice of operation of iatrogenic esophageal injuries depends on type, localization and time interval from trauma. The possibilities of using stenting, clipping and vacuum therapy of esophageal wounds require further research.