Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVII: Wounds and Injuries of the Neck

Wounds of the Pharynx and Esophagus

United States Department of Defense

The pharynx and esophagus are often involved in injuries of the neck, with resultant high likelihood of contamination of the deep fascial planes of the neck and the mediastinum. Small lesions of the posterior pharynx and esophagus are often overlooked in the presence of other neck injuries and can lead to severe morbidity and death. Examination must be thorough and includes endoscopy, Any penetrating injury, however small, must be suspect. Soft-tissue X-ray films may be useful as previously described. Radiopaque contrast media may demonstrate leaks not apparent by other means.

Management is based on surgical exploration, both to identify lesions and to debride and close lacerations of the mucosa and muscularis of the pharynx and esophagus. Double-layer closure of defects is the treatment of choice, followed by adequate external drainage. Wide wounds of the pharynx or esophagus which cannot be closed require either marsupialization or wide drainage. Nasogastric intubation is necessary early on to minimize wound contamination secondary to regurgitation and later on for feeding purposes.

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Operational Medicine 2001

Health Care in Military Settings

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