Traumatic esophageal injuries: 12-year experience at Henry Ford Hospital.

We reviewed our 12 years' experience and the literature on traumatic and nontraumatic esophageal injuries. A total of 28 patients were diagnosed and managed at Henry Ford Hospital. Cervical esophageal injuries should be explored surgically as soon as possible but, in our experience, a negative contrast swallow has not been reliable. In thoracic esophageal injuries, however, we rely more on contrast swallow to avoid routine exploratory thoracotomy and its morbidity. Abdominal esophageal injuries are readily identifiable during exploratory laparotomy performed for other abdominal injuries. Early diagnosis and treatment are the key to a successful outcome.

Choledochoscopy as a complementary procedure to operative cholangiography in biliary surgery.

Six years' experience with the use of the flexible choledochoscope for biliary is reported. One hundred forty-nine patients underwent common bile duct exploration with choledochoscopy as a complementary procedure. Choledochoscopy immediately showed the absence of stones in 37 patients in whom stones were suspected but the results of preexploratory operative cholangiography were negative or equivocal. The remaining 112 patients underwent choledocholithotomy with choledochoscopy. Only two patients (1.3 percent) returned with unsuspected residual stones. Choledochoscopy used as a complementary procedure to operative cholangiography can easily and more accurately clarify suspicious findings in the operative cholangiogram. It avoids the use of blind instrumental exploration of the bile ducts. Impacted stones can be extracted easily under direct vision with the choledochoscope. We believe that the use of choledochoscopy contributed to our low incidence of retained stones.