War-related penetrating cervicothoracic trauma managed in a resource-limited hospital in Syria: a case series.

Authors

Issam Alkhayer, Mohammad Alaa Aldakak, Youssef Abbas

Published in

International journal of emergency medicine. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

Penetrating cervicothoracic trauma in war is time-critical because airway, major vascular, and aerodigestive injuries may coexist, rapidly causing hypoxemia, exsanguination, or pleural/mediastinal contamination. CT can support triage and operative planning in transportable patients, while bronchoscopy, vascular imaging, and contrast/endoscopic esophageal studies may further refine assessment when available.
We reviewed consecutive war-related penetrating neck/upper-chest injuries treated at a military hospital in Syria between 2015 and 2017. Inclusion required intraoperative confirmation of tracheal, major thoracic vascular, or esophageal injury. Three male patients underwent emergency surgery. Case 1 presented with profound hypoxemia, extensive subcutaneous emphysema, pneumomediastinum, and persistent massive air leak after drainage. CT suggested tracheal disruption; right thoracotomy revealed a longitudinal tracheal laceration with tissue loss approximately 3 cm below the cricoid, extending 2 cm. Case 2 arrived in profound shock with absent left upper-limb pulses and massive hemothorax; trap-door exploration identified complete left subclavian artery transection. Case 3 had CT evidence of a retained projectile near the mid-esophagus and right hemopneumothorax; food-like pleural drainage prompted thoracotomy, confirming a 4-cm mid-esophageal tear.
Management was physiology-driven. The tracheal injury was repaired with interrupted absorbable sutures and intercostal muscle-flap buttress. The subclavian artery was reconstructed with an interposition graft, restoring distal pulses. The esophageal injury underwent primary repair with broad-spectrum antimicrobials.
In austere conflict settings, CT-informed triage plus decisive operative management can be lifesaving, but imaging should not delay exploration when hard clinical signs persist.

PMID:
42410359
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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