Cervical esophageal trauma. Incidence and cause of esophageal fistulas

R. P. Winter and J. A. Weigelt
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.

Esophageal fistulas occurred in 4 (9%) of 46 penetrating esophageal wounds. All four patients with fistulas were victims of gunshot wounds, presented in shock, and underwent an urgent tracheostomy in the emergency department. Shock and urgent tracheostomy were significantly associated with fistula formation. Whether single-layer closures are adequate for esophageal wounds remains unanswered. Our data showed no disadvantage to single-layer closure, since seven of eight were successful. This compares with a success rate for multilayer closures of 32 of 35. Fifty percent of the esophageal fistulas were asymptomatic and were discovered on routine postoperative contrast study. All fistulas closed with nonoperative management. Management recommendations included nonoperative means to establish an airway, meticulous debridement, two-layer closure of the wound, closed-suction drainage, and postoperative esophagography before drain removal.