Conservative management of a traumatic perforation of the thoracic esophagus

Esophageal perforation secondary to blunt trauma carries a high morbidity and mortality rates. It is a rare disease. Cervical esophagus is the commonest site of perforation. Numerous options are available for the management of esophageal injuries. The conservative medical management is allowed in well defined cases. We report a rare clinical case of a 40-year- old patient who was injured in a car accident with an impact to the anterior chest. At the time of admission, the patient was alert and complained of chest pain. Clinical findings showed of subacute ischemia in the right upper limb. Chest computed tomography [CT] with intraveinous contrast showed thrombosis of the brachiocephalic artery [a few air bubbles, in the upper mediastinum and a bilateral pneumothorax]. The diagnosis of esophageal perforation was confirmed by a second CT with ingestion of a water-soluble contrast agent. Outcome was favourable on antibiotics and parenteral nutrition. Provided that no clinical signs of sepsis are present and that the patient rapidly improves the conservative management of traumatic perforation of the thoracic oesophagus is a sounded option

Haemobilia after blunt hepatic traumatism: interest of the arteriography and the embolisation

The hemobilia is the result of a pathological communication between bile ducts and vessels the intra or extra hepatic. We reported a case of a 48 year old patient who was admitted to emergency service for an accident of the public highway with a central hepatic-hematome, detected by scanner. The treatment consisted of a simple monitoring. Three weeks after the hepatic contusion, the patient developed a hemobilia by cracking of intra hepatic a pseudoaneurism in the bile ducts, the diagnosis had been evoked by the presence of hematemess, directed by Doppler echo, and confirmed by the coeliace arteriography. The haemostasis was successfully treated by precutneous arteriographic embolisation. Without recurrence for two years. The post traumatic hemobilia is a rare complication of the hepatic contusions, observed in 0.5 to 2 percent of the cases. Traditional symptomatology gathers three signs or triad of Sandbloom, which biliary colics, ictere and diagestive haemorrhage. Pulsated the Doppler echo is an effective examination in the tracking of the hepatic aneurisms. The surgery which was formerly the treatment of choice of the hemobilies currently left place to the percutaneous embolisation