Background: Transmediastinal gunshot injuries are a rarely reported injury. Until recently, assessment of the thoracic aorta by angiography preceded the investigation of the esophagus. This order has been recently debated. Methods: There were 118 patients with potential transmediastinal injuries included in this retrospective study. Unstable patients who were unresponsive to resuscitation were taken to the operating room without previous investigation. Stable patients were routinely investigated initially for injury of the aorta and then for injury of the esophagus. Results: There were 51 patients who underwent urgent thoracotomy/sternotomy. In 27, the hemorrhage was of mediastinal origin; 17 of these patients died of intraoperative bleeding. Eight of the patients had aortic injury, and only one of this group survived. There were 57 stable patients who were investigated initially for injury of the aorta by angiography. It was positive in only one patient who underwent an operation with good results. An investigation of the esophagus followed and revealed esophageal injury in 17 patients. All of them were treated operatively, 15 of them with satisfactory outcome. Conclusions: Angiography should at present precede esophageal investigations. There is a need for shortening the time between admission and operation. Other modalities that could expedite the investigation of the thoracic aorta and the esophagus should be prospectively evaluated in multi-center studies. (Surgery 2000;128:54-8.)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Management of combined penetrating cardiac and abdominal trauma.Injury. 1997; 28: 343-347
- Management of transmediastinal gunshot wounds.Surgery. 1981; 90: 671-676
- Transmediastinal gunshot wounds—a reconsideration of the role of angiography.Arch Surg. 1996; 131: 949-953
- Detection and evaluation of aerodigestive tract injuries caused by cervical and transmediastinal gunshot wounds.J Trauma. 1997; 42: 680-686
- Penetrating wounds of the cervical oesophagus.Am J Surg. 1975; 130: 863-871
- Diagnosis and management of external penetrating cervical oesophageal injuries.Ann Otol Rhino Laryngol. 1994; 103: 863-871
- Penetrating thoracic aortic injuries: a rare but potentially salvageable sequelae of urban warfare.South Med J. 1989; 82: 970-972
- Determining anatomic injury with computed tomography in selected torso gunshot wounds.J Trauma. 1998; 45: 446-456
- Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT—five years experience at a major trauma center.Radiology. 1996; 200: 413-422
- Gunshot wounds to the thoracic aorta in the 90's: only prevention will make a difference.Am Surg. 1995; 61: 721-723
Accepted: February 13, 2000
*Reprint requests: E. Degiannis, MD, FRCS, Department of Surgery, Medical School, 7 York Road, Parktown 2193, Johannesburg, Republic of South Africa.
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.