A RARE SELF-INFLICTED STABBING TO THE NECK INJURING THE DISTAL TRACHEA AND PROXIMAL ESOPHAGUS.

Objectives:

Introduction:
Penetrating neck trauma poses significant risk to multiple vital structures, including the trachea and esophagus, which if not treated immediately may lead to devastating consequences. We report the successful treatment of a patient with both a distal tracheal and thoracic esophageal injury from the same entry point above the sternal notch.

Case Presentation:
Our patient initially presented as a trauma after sustaining self-inflicted stab wounds to the neck. There was obvious air escape from a midline wound overlying the sternal notch. He was taken to operating room emergently for exploration. Intra-operatively, a left neck exploration and a median sternotomy were performed revealing a distal tracheal injury posterior to the root of the aorta. Following repair and buttress with posterior pericardium, an EGD was performed and discovered a much more proximal left sided full-thickness esophageal injury. These injuries were approximately 15cm apart. Both injuries were the result of separate stab entries originating from the same external midline wound. The esophageal injury was repaired and buttressed with the sternocleidomastoid. He was admitted to the ICU postoperatively. The patient did well post-operatively and was able to tolerate a mechanically altered diet before being discharged home with family.

Conclusion
Our case report describes the successful repair of both a distal tracheal injury and esophageal injury after penetrating trauma using pericardial and strap muscle flaps, respectively. Additionally, this patient stabbed himself more than once in the same wound resulting in separate traumatic pathologies in different anatomical locations. To our knowledge this case report is unique in bringing this circumstance to the literature, demonstrating the importance of full intra-operative examination to assess for concomitant wounds in stab injuries after the initial pathology has been found and the initial stab trajectory understood.

Methods:

Results:

Conclusion: