Thoracic and Chest Disease
The gold standard is to require an open thoracotomy, possible repair, wide drainage, and buttressing with perfused tissue, and all this with tenuous results, as the esophageal blood supply is minimal. The morbidity and mortality rates of esophageal perforations are high. Endoscopic stents have changed the management of this disease with improved outcomes. Chest tubes are placed with the classic teaching of larger tubes for fluid and smaller tubes for air. In a study by Inaba et al., prospective data was collected in patients requiring chest tubes from trauma and compared large versus small tubes with a total of 353 tubes placed in 293 patients. There were no differences in complications or additional procedures needed in the two groups and no difference in pain reported by patients. The emergency surgeon can help expedite the care of these patients, working closely with their endoscopic/thoracic colleagues to assure the optimal care for the patient.