Abstract
The patient was a 73-year-old man who had directly been injured his anterior cervical region by a broken blade when he was at work to smash concrete. Emergent operation was performed with the diagnosis of complete disruption of the cervical trachea combined with injury of the cervical esophagus and bilateral recurrent nerves. We evaluated that primary end-to-end anastomosis of the trachea was risky because the recurrent nerves were bilaterally completely disrupted, correspondingly anastomosis of the disrupted esophagus with dark colored edematous mucosa was unsafe. Therefore, we performed laryngo-tracheal separation with definitive tracheostomy and two esophago cutaneo stomies esophageal fistulostomy, and then we created feeding gastrostomy. After a 43-day continuous drainage of saliva using a nasogastric tube inserted to the proximal esophageal fistula to prevent wound infection, we performed the staged operation of digestive reconstruction. After performing laryngo-pharyngectomy and cervical esophagectomy, we reconstructed the defect of the alimentary tract using a free jejunal graft with vascular anastomosis. The postoperative course was smooth, and he resumed oral intake of rice gruel. He was discharged from the hospital on the 38th day after the reconstruction surgery. We here report a case of traumatic complete disruption of the cervical trachea and esophagus treated successfully by using a strategic two-stage operation.
