Penetrating Mediastinal Trauma: A Case Report

Background:The penetrating mediastinal trauma due to perforation of the esophagus or hypo pharynx is rare and there is controversy in the diagnosis and treatment depending on the location and type of agent and the patient s condition. We present a very rare case of penetrating hypo pharyngeal trauma and reviews the related articles.Case report:A 5-year-old boy who has fallen on a screwdriver while running, with an initial diagnosis of rupture of the esophagus due insertion of screwdriver handle, through his mouth to posterior esophagus space of the mediastinum. After a rapid first diagnostic steps contain history and physical examination, laboratory tests and imaging and preoperative preparation, the patient had drooling and respiratory problem and mediastinal and sub cutaneous emphysema and a low grade fever the patient was transferred to the operating room urgently.Under general anesthesia, the impacted screwdriver handle was removed by laryngoscopy, and then on the posterior throat a defect was detected with a diameter of close to 1 cm, without any pus or active hemorrhage by esophagoscopy.The patient was transferred to the ICU with intra tracheal tube, intravenous antibiotic therapy, NPO, TPN for 1week. esophago gram next with water soluble contrast revealed: patency of esophageal defect and a pouch on the posterior space of esophagus.For feeding a gastrostomy was performed. After 2 weeks CTS of chest with water soluble contrast revealed closure of the pharyngeal defect, we began oral feeding and gastrostomy tube was extracted later on and the patient was discharged with good condition. After 2.5 years out patient fallow up the child was good without any problem.Conclusion:If in review of the texts there are some helpful guide lines for management of children individualized with penetrating pharyngeal trauma but treatment should be individualized in any patients.