Traumatic tear of aorta, trachea, and esophagus in a 7-year-old survivor.

In August 1996, a 7-year-old boy was crushed from behind into the steering wheel of a go-cart, suffering a tear of his right innominate artery into the aortic arch, a 2-inch tear of the posterior trachea into left main bronchus, and 2 4-inch tears in the esophagus. These were all repaired on cardiopulmonary bypass through a sternotomy; a Gor-tex (W. L. Gore and Associates, Flagstaff, AZ) graft was required for the arterial repair. His recovery was complicated by a midesophageal stricture and a nearby fistula to the left main bronchus, which caused frequent lung infections and 12 hospital admissions over 2(1/2) years. During this time he had his stricture dilated 5 times and resected twice, his fistula surgically closed twice and glued 4 times, and an antireflux procedure, pyloroplasty, and gastrostomy for his persistent gastroesophageal reflux. He also had 2 esophageal stents placed; the first (titanium) lasted 4 months and the second (SILASTIC(R) [Dow Corning, Midland, MI]) 1 year later lasted 9 months, solving both the stricture and fistula problems and spontaneously passing through and out of his gastrointestinal tract. Throughout this recovery time, his nutrition was maintained mostly by gastrostomy feeding, supplemented by total parenteral nutrition and oral feeding when able. After 2(1/2) years of treatment, all has returned to normal, and he has remained well for the last 2(1/2) years (April 2001). He still is on Omeprazole. Copyright 2002 by W.B. Saunders Company.