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Imaging the oesophagus after penetrating cervical trauma using water-soluble contrast alone: simple, cost-effective and accurate
  1. L Nel1,
  2. L Whitfield Jones2,
  3. T C Hardcastle3
  1. 1
    General Surgery, University of Stellenbosch, Tygerberg, South Africa
  2. 2
    Trauma Team, Tygerberg Hospital, Western Cape, South Africa
  3. 3
    Trauma Service, Tygerberg Hospital and Department of Surgery, University of Stellenbosch, Western Cape, South Africa
  1. Dr T C Hardcastle, PostNet Suite 27, Private Bag X05, Malvern, 4055 Durban, South Africa; timothyhar{at}ialch.co.za

Abstract

Aim: This audit aims to gauge the safety and efficacy of iso-oncotic water-soluble contrast media as the sole imaging evaluation of the distal pharynx and cervical oesophagus after penetrating cervical trauma.

Methods: A retrospective audit was performed over a 4-year period of all patients with penetrating cervical trauma to zones 1 and 2 of the neck who were subjected to imaging evaluation as part of a selective non-operative management policy for penetrating cervical trauma. The outcome was reviewed and the sensitivity, specificity and predictive values of the investigation were determined. The surgical management of identified injuries is also described.

Results: Four hundred and sixty-five contrast studies were included with 11 studies positive for pathology (9 injuries, 2 incidental findings). Surgery was undertaken in 4 patients with cervical oesophageal injuries and conservative management was carried out in 5 cases of distal pharyngeal injury. No missed injuries and no significant adverse events were identified during the study period.

Conclusion: A contrast study of the oesophagus with water-soluble iso-oncotic contrast media as the sole diagnostic imaging modality is safe (avoiding the risk of aspiration pneumonia), reliable (identifying all injuries) and cost-efficient (avoiding the need for additional expensive investigations) in cases of penetrating cervical trauma.

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Footnotes

  • This paper was presented as a 10 minute presentation at the University of Stellenbosch 2007 Annual Academic Research Day. The abstract was published in the Abstract booklet which was available on the internet until the end of 2007.

  • Funding: None.

  • Competing interests: None.

  • Ethics approval: This study constituted a retrospective chart audit with total patient anonymity and, as such, was exempted from formal ethics committee approval. It was, however, approved by the Department of Surgical Sciences Research Committee.

  • Contributors: LN identified the patients from the database, analysed the data, reviewed the surgical procedures and outcomes, prepared the PowerPoint presentation and presented the research at the 2007 Annual Academic Research Day. LWJ assisted in accessing the patient radiology files, collating the data into the database and reviewing the contrast studies to assess the accuracy of the radiological reports. TH conceived the idea for the study, supervised the data collection and assisted in the preparation of the abstract and presentation at the Research Day and undertook the literature review and prepared the final manuscript. TH acts as the guarantor of the study.

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