Abstract
We experienced a case of cervical esophageal transmural injury, successfully treated with simple closure of the injured site, transcervical vascular sheath mediastinal drainage and open paramedian tracheostomy with no contamination between the contaminated surgical wound and tracheostomy site. A 47-year-old man with schizophrenia swallowed a piece of a glass bottle. CT showed incarcerated glass in the cervical esophagus and deep cervical and mediastinal emphysema. He was transferred to our center because of cervical esophageal injury without respiratory or circulatory deterioration. In the operating room of our center, we found no glass in the esophagus and he underwent gastrotomy, removal of the piece of glass, and the gastrostomy with simple closure of the injured cervical esophagus and transcervical vascular sheath mediastinal drainage using an oblique cervical approach and open paramedian tracheostomy. We reached the posterior wall of the cervical esophagus via an incision on the anterior edge of the sternocleidomaastoid muscle, and inserted a tube drain for continuous aspiration along the cervical vascular sheath to the mediastinum. Finally, we performed an open paramedian tracheostomy as far from the surgical wound for esophageal surgery as possible. We confirmed oblique insertion of the tracheostomy tube by postoperative bronchofiberscopy and CT images. The tracheostomy tube was easily changed through the paramedian tracheo-cutaneous fistula.
