A utility of video-assisted thoracoscopy (VATS) for management of gunshot injury to the esophagus in Role 2 hospital: case report from Russia-Ukraine war.

Importance: The Russo-Ukrainian war is associated severe gunshot injuries to various locations. The gunshot injury to the esophagus is rare condition requiring differential clinical approach.The aim of the study was to demonstrate the specific features of a management of combat patient with penetrating gunshot shrapnel wound to the chest with the injury to the esophagus in the ongoing war in Ukraine. Case presentation: A 46 years old male patient was wounded by artillery shelling in East Ukraine. CT scan showed presence of a metal density foreign body 22 × 7 mm in the mediastinum between the trachea and the esophagus. The video-assisted thoracoscopy (VATS) was applied followed by mobilization of the esophagus in the area of its damage and a metal fragment of 22 × 7 mm was identified within the esophageal wall and removed by endoscopic tool. The patient was discharged on the 12th post-operative day. Clinical discussion: In this study we demonstrated a rare case of war-related gunshot injury to the chest with damage to the esophagus, that was managed by using VATS. Penetrating gunshot wounds to the chest with esophagus injuries are a rare and its management is difficult task. Conclusions: To summarize, the gunshot injury in the ongoing Russo-Ukrainian war is severe with presentation of rare injuries to chest with damage to the esophagus. The whole-body CT scan is important diagnostic tool to identified all injuries, including rarely damage to esophagus. The application of VATS might be applied for gunshot wounds to the esophagus in combat settings for selected patients in Role 3 and 4 deployed hospitals.