approach allows access to the trachea and right-sided bronchial injuries, while
the left approach permits access to left bronchial injuries. Hilar exposure is
achieved with anterior retraction of the lung. Primary repair is completed with
interrupted simple absorbable sutures. Tenuous repairs may be reinforced with
a well-vascularized tissue buttress from an intercostal muscle pedicle flap.
G. Esophageal Injuries
Traumatic esophageal injuries are extremely rare in pediatric trauma.
This is primarily because it is a mobile mediastinal structure in children and it is
well-protected in the posterior mediastinum of the thoracic cavity. Although it is
an uncommon injury, it remains clinically significant because esophageal
perforation with mediastinal contamination is associated with high morbidity and
mortality.
Perforation or rupture of the esophagus can rarely occur with rapid
intraluminal pressure elevation following high-impact blunt force trauma. More
commonly esophageal injuries are the result of penetrating injury to the neck or
chest. Esophageal injuries tend to have an occult presentation, therefore
suspicion should be raised in patients with the appropriate mechanism to
prevent delay in diagnosis. On clinical exam, fever, chest tenderness, or
crepitus may be appreciated. A chest x-ray may reveal pneumomediastinum
and subcutaneous air. Depending on the location of the esophageal injury and
degree of esophageal leakage, a pleural effusion may also be present.