Abstract
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.)
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Article info
Publication history
Accepted:
February 13,
2000
Footnotes
*Reprint requests: E. Degiannis, MD, FRCS, Department of Surgery, Medical School, 7 York Road, Parktown 2193, Johannesburg, Republic of South Africa.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
