2024 Military Poster Presentations

Ester Gilbert, MD1; Michelle Medintz, MD2; Carl Freeman2; 1Dwight D. Eisenhower Army Medical Center; 2Saint Louis University Hospital

Objectives: Recidivism is the idea that a prior injury pattern causes worse outcomes on a subsequent injury.  Our objective is to present a rare case of recidivism resulting in the largest reported blunt thoracic esophageal injury resulting in the patient’s survival and an associated blood transfusion reaction.

Methods: We analyzed the diagnostic assessment and management of a large thoracic esophageal injury and transfusion reaction in a single patient who sustained significant blunt polytrauma, with significant past medical history of penetrating chest trauma requiring extensive chest surgery, abdominal surgery, and massive blood transfusion. We reviewed and discussed the literature regarding blunt esophageal trauma to highlight the extraordinary nature of this case in the context of recidivism. 

Results: The patient—a mid-twenty-year-old African American male who survived a remote gunshot wound to the chest requiring clamshell thoracotomy, laparotomy, and massive blood transfusions—presented as a pedestrian struck by a motor vehicle.  The patient sustained significantly more complex polytrauma secondary to recidivism; the patient had developed adhesions following his previous thoracic trauma likely leading to tethering and considerable tearing of the esophagus when he was later struck by a vehicle. This is evidenced by the known rarity of blunt esophageal injury (incidence of approximately 0.001%) and that it is likely to occur in patients who are older, female, and white (Beal et al.). Further, most blunt esophageal injuries occur in the cervical esophagus, whereas our patient’s injury occurred in the thoracic esophagus (Nygaard et al.).  Recidivism is further illustrated by the patient’s transfusion reaction as the patient received uncrossmatched O-(Rh)positive blood during both his initial and presenting traumatic injuries. 

Conclusion: This idea of recidivism causing a subsequently worse outcome because of the prior injury patterns themselves has not been extensively studied. This case discusses an unusual and extensive esophageal perforation and a blood transfusion reaction that was complicated because of the patient’s previous traumatic injuries.  This case not only contributes to the small number of cases resulting in survival from blunt thoracic esophageal trauma, but it also highlights a specific scenario where adhesive disease from previous penetrating trauma and prior blood transfusion contributed to the injury’s complexity and severity. This study and associated literature review presents an opportunity for additional research into recidivism, which can positivity influence community outreach and injury prevention.