Computed tomography as a method of substantiating a minimally invasive approach in the treatment of esophageal injuries and their complications

The purpose of the study. To analyze possibilities of computed tomography (CT) for esophageal injuries and their complications as part of a differentiated approach to the choice of a minimally invasive treatment method.

Materials and methods. The results of CT scans were analyzed in 25 patients with esophageal injuries of various etiologies who were treated at the N.V. Sklifosovsky Research Institute of SP in the period 2019–2020. CT was performed with oral and intravenous bolus contrast, primarily at admission and in dynamics, a total of 77 studies.

Results. In all cases, direct and indirect CT signs of esophageal damage were detected, and the degree of involvement of surrounding organs and tissues in the pathological process was assessed. Based on the data obtained, the following variants of esophageal damage and its complications were identified: intramural esophageal hematoma (2); rupture of the thoracic esophagus without the development of purulent complications (2); rupture of the thoracic esophagus complicated by the development of mediastinitis (4); rupture of the thoracic esophagus with the development of mediastinitis and pleural empyema (13); rupture of the cervical calving of the esophagus, complicated by phlegmon of the neck and descending mediastinitis (4). Different patient management tactics were used for each variant. Thus, the selection and sequence of minimally invasive interventions, such as thoracoscopic sanitation mediastinal and pleural cavity, esophageal stenting, percutaneous endoscopic gastrostomy (CEG) and endoscopic vacuum aspiration system (E-VAS), were carried out taking into account CT data, including observations in dynamics.

Conclusion. CT scan for esophageal injuries allows you to get complete information about both the nature of esophageal damage and its complications, to determine their type, localization and volume. CT data allow us to justify a minimally invasive approach in the treatment of esophageal injuries, to determine the order of interventions. CT studies performed in dynamics allow us to evaluate the effectiveness of treatment and to carry out timely correction of tactics.

1. Abakumov M.M. Mediastinitis: a guide for physicians. Moscow:, SIMK, 2020. 296 p. (In Russian)

2. Brednev A.O. Povrezhdeniya pishchevoda: diagnostika i sovremennaya taktika lecheniya. Vestnik Rossiyskoy voyenno-meditsinskoy akademii. 2015; 3 (51): 255–260. (In Russian)

3. Teremov S.A. The peculiarities of surgical treatment of esophageal injury in patients of old age. Nablyudeniya iz praktiki. 2011; 3 (8): 177–179. (In Russian)

4. Biancari F., D'Andrea V., Paone R., Di Marco C., Savino G., Koivukangas V., Saarnio J., Lucenteforte E. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. Wld J. Surg. 2013; 37 (5): 1051–1059. http://doi.org/10.1007/s00268-013-1951-7

5. Wahed S., Dent B., Jones R., Griffin S.M. Spectrum of oesophageal perforations and their influence on management. Br. J. Surg. 2014; 101 (1): e156–162. http://doi.org/10.1002/bjs.9338

6. Grishin I.N. Cardiospasm, achalasia of the cardia and perforation of the esophagus. Minsk: Vysheyshaya shkola, 2013. 192 p. (In Russian)

7. Ivatury R.R. Oesophageal injuries: Position paper, WSES, 2013. Wld J. Emerg. Surg. 2014; 1 (9): 9. https://doi.org/10.1186/1749-7922-9-9

8. Ben-David K., Lopes J., Hochwald S., Draganov P., Forsmark C., Collins D., Chauhan S., Wagh M.S., Carreras J., Vogel S., Sarosi G. Minimally invasive treatment of esophageal perforation using a multidisciplinary treatment algorithm: a case series. Endoscopy. 2011; 43 (2): 160–162. http://doi.org/10.1055/s-0030-1256094

9. Shestyuk A.M. The role of instrumental diagnostic methods in detecting injuries of the thoracic esophagus. Novosti khirurgii. 2010; 5 (18): 20–27. (In Russian)

10. Trufanov G.E. Radiation diagnosis of diseases of the esophagus. Leadership. SPb: Elbi-SPb, 2011. 192 p. (In Russian)

11. Ba-Ssalamah A., Zacherl J., Noebauer-Huhmann I.M., Uffmann M., Matzek W.K., Pinker K., Herold C., Schima W. Dedicated multi-detector CT of the esophagus: spectrum of diseases. Abdom. Imaging. 2009; 34 (1): 3–18. http://doi.org/10.1007/s00261-007-9290-5

12. Buryakina S.A. Value of mdct with bolus contrast enhancement in differential diagnosis of esophageal stenosis. Russian Electronic Journal of Radiology (REJR). 2015; 5 (3): 22–29. (In Russian)