What is the operative report for a patient who underwent neck laceration exploration with negative intraoperative bronchoscopy (intraoperative examination of the airways) and esophagogastroduodenoscopy (EGD) (examination of the esophagus, stomach, and duodenum)?

Operative Report: Neck Laceration Exploration with Negative Intraoperative Bronchoscopy and EGD

Preoperative Diagnosis

Penetrating neck trauma with laceration requiring surgical exploration

Postoperative Diagnosis

Penetrating neck trauma with laceration; no aerodigestive tract injury identified

Procedure Performed

1. Neck laceration exploration
2. Intraoperative flexible bronchoscopy
3. Intraoperative esophagogastroduodenoscopy (EGD)

Indication

The patient presented with penetrating neck trauma requiring surgical exploration based on hard signs of injury (such as active hemorrhage, expanding hematoma, or airway compromise) or soft signs warranting operative evaluation. 1 Intraoperative endoscopy was performed to assess for occult aerodigestive tract injuries that may not be apparent on external examination. 2

Anesthesia

General endotracheal anesthesia

Procedure Details

Neck Exploration

• Patient positioned supine with neck extended and cervical spine precautions maintained if indicated. 1
• Incision made along the anterior border of the sternocleidomastoid muscle (or as dictated by wound trajectory)
• Systematic exploration performed examining:
  • Vascular structures (carotid artery, internal jugular vein, vertebral vessels)
  • Aerodigestive tract (pharynx, larynx, trachea, esophagus)
  • Neural structures (vagus nerve, recurrent laryngeal nerve)
  • Thyroid gland and surrounding soft tissues 3
• Hemostasis achieved with electrocautery and ligatures as needed
• No evidence of major vascular injury identified
• No obvious perforation or laceration of the trachea or esophagus noted on external examination

Intraoperative Flexible Bronchoscopy

• Flexible bronchoscope introduced through the endotracheal tube after coordination with anesthesia. 2
• Systematic examination performed including:
  • Vocal cords and laryngeal structures
  • Trachea from subglottis to carina
  • Right and left mainstem bronchi
  • Segmental bronchi as visualized 2
• Mucosal surfaces examined for lacerations, hematomas, or areas of injury
• No mucosal lacerations, perforations, or significant injuries identified 2
• No active bleeding or hematoma formation noted
• Airway patency confirmed throughout

Intraoperative Esophagogastroduodenoscopy

• Flexible upper endoscope introduced through the oropharynx under direct visualization. 4
• Systematic examination performed with high-definition imaging: 5
  • Upper esophageal sphincter
  • Cervical, thoracic, and distal esophagus
  • Gastroesophageal junction
  • Gastric fundus (with retroflexion/J-maneuver)
  • Gastric body and antrum
  • Pylorus and duodenal bulb
  • Second portion of duodenum 5
• Adequate mucosal visualization achieved with air insufflation and aspiration of secretions 5
• Photo-documentation obtained of all anatomical landmarks 5
• No mucosal lacerations, perforations, hematomas, or areas of injury identified throughout the entire examined length 4
• No active bleeding or evidence of perforation noted
• Esophageal mucosa intact without signs of trauma

Wound Closure

• Wound irrigated copiously with normal saline
• Hemostasis confirmed
• Platysma reapproximated with absorbable suture
• Subcutaneous tissues closed in layers
• Skin closed with interrupted sutures or staples
• Sterile dressing applied
• Drain placement: [specify if drain placed and type]

Estimated Blood Loss

[Specify amount] mL

Specimens

None

Complications

None

Disposition

• Patient transferred to recovery room in stable condition
• Postoperative management includes close monitoring for signs of delayed complications including anastomotic leak, abscess formation, or recurrent laryngeal nerve injury 3
• Serial physical examinations to assess for subcutaneous emphysema, dysphagia, dysphonia, or respiratory distress 3, 1
• NPO status initially with advancement of diet as tolerated based on clinical course
• Antibiotics as indicated for wound contamination
• Follow-up imaging (CT with contrast) if clinical deterioration or new symptoms develop 3

Findings Summary

Intraoperative bronchoscopy and EGD were negative for aerodigestive tract injury, confirming the integrity of the airway and esophagus despite penetrating neck trauma. 2, 4 This approach allowed for definitive assessment and guided appropriate surgical management, avoiding unnecessary extensive resection. 4

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Clinical Note: The use of intraoperative endoscopy in penetrating neck trauma has a technical success rate of 100% when performed by experienced operators and is critical in assessing and guiding surgical repair of injuries noted on exploration. 2, 4 In this case, the negative findings provided reassurance that no occult aerodigestive injuries were present, allowing for primary wound closure without need for complex reconstruction. 2