The incidence of esophageal rupture due to blunt chest trauma has been reported to be 0.001% . Its mortality rate was about 20% in a recently published large case series . Mortality rate is increased when there is a delay in its diagnosis. Some papers report that if treatment is delayed for more than 24 hours after injury, mortality could increase by nearly 50% . Unfortunately, 70% of esophageal rupture due to blunt trauma is diagnosed late with a poor prognosis .
The treatment strategy for esophageal rupture has not been established yet. Several studies have shown that early diagnosis and management are associated with good clinical outcomes and that the golden time for treatment is usually within 24 hours . Whether to perform primary repair or not depends on time. If esophageal rupture is diagnosed within 24 hours of injury and the patient is stable, primary repair with or without pleural or muscle flap may be attempted . However, if more than 24 hours have passed since injury and if a patient is unstable, other methods such as esophageal diversion and exclusion should be considered .
Indications for esophageal stent are usually divided into two groups. The first indication is malignant or benign dysphagia . The second indication is esophageal leakage . Although there is no absolute contraindication, esophageal perforation longer than 6 cm is a relative contraindication . The advantage of esophageal stent is that it can provide nutritional support through early feeding. However, a relatively high risk of adverse events, particularly stent migration, is a major limitation of the use of esophageal stent .
In our case, we missed the possibility of thoracic esophageal rupture because there was liver laceration required emergent treatment and chylothorax can develop after abdominal trauma without chest trauma. The patient’s condition was getting worse and total left lung field haziness led to surgery on the sixth day after trauma. According to the operative findings, most of esophageal mucosa was intact, primary repair was performed. However postoperative esophageal leak occurred due to delay in diagnosis and surgery. Considering the patient’s poor condition, future quality of life and the relatively small size of esophageal leak, redo esophageal repair or other surgery, such as esophageal exclusion and diversion, was inappropriate. So, we decided to treat postoperative esophageal leak with esophageal stent. Esophageal stent was maintained for six weeks without complications. No leaks or other complications remained after stent removal.