DELAYED PRESENTATION OF A TRAUMATIC ESOPHAGEALPERFORATION& THE PHYSICAL AS WELL AS MENTAL BURDENASSOCIATED WITH IT

Esophageal perforations are an uncommon entity with an incidence of 3.1 per 1,000,000 per year in the USA. (1).There are numerous causes of esophageal perforations, the commonest ones being iatrogenic (those that occur secondary to esophageal instrumentation - endoscopy or post surgical repairs)and spontaneous(Boerhaave Syndrome). Among all esophageal perforations, the reported incidence of traumatic esophageal rupture varies from 4% to 14%. (2), (3).Esophageal injury following blunt chest trauma is extremely rare (up to 0.1%). (4)Hence , we present a case of a middle aged male who presented to our emergency department withhistory of progressively worseningleft sided chest pain, shortness of breath and lethargy since last 5 days. Chest Xray revealed a large left sided suspected hemo/hydropneumothorax for which an Intercostal drain was placed  but a large amount of frank purulent discharge was drainedinstead of the anticipated blood/fluid. On further probing , patientrevealed history of blunt trauma to chest12 days priordue to a road traffic accident. The finding of empyema warranted urgent further evaluation. Hence a contrast Computed Tomography scan of the chest was done which revealed an intrathoracic esophageal perforation communicating to the left pleural space. This is a rare and interesting case for a few reasons Anesophageal perforation secondary to blunt chest trauma is a rare entity, this patientpresented to us after almost 2 weeks of trauma and the presenting symptoms led us to makea differential diagnosis of a post traumatic hydro/hemothorax vs an infected hydropneumothorax / empyema (? Tubercular). Hence, thorough history takingenabled us to take a quick and calculated step to rule inesophageal perforation.