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The traditional approach to penetrating injuries to zone II of the neck has included operative neck exploration, extensive enough to allow for proximal and distal vascular control of the potential vascular injury. Few studies have reported cases of entirely endovascular management of penetrating injury to this portion of the neck. In the present case report, we describe the case of a 38-year-old man who had sustained a stab wound to zone II of the neck. The injury to the internal carotid artery was managed endovascularly with placement of a covered stent. The findings from the present case illustrate the potential use of minimally invasive vascular treatment strategies as an alternative to mandated operative intervention.

Objective: The traditional approach to penetrating injuries to zone 2 of the neck includes neck exploration extensive enough to allow proximal and distal vascular control of potential vascular injury.¹ Only a few recent case reports have been published on the use of covered stents in traumatic internal carotid artery (ICA) injury with good functional results.^2,3 Some centers have studied nonoperative management of venous injury in the neck after penetrating trauma, but no reports of endovascular evaluation of the venous system in penetrating neck trauma exist.⁴ Methods: A 38-year-old man presented to the emergency department with a 2-cm laceration to the right posterior triangle of the neck. Glasgow Coma Scale score on presentation was 12. With no overt signs of hemorrhage, a computed tomography angiogram was obtained, showing hematoma surrounding the right ICA with irregularity and tapering of the true lumen at the level of C2 to approximately 70%. Delayed-phase imaging suggested injury to the right internal jugular vein. After the wound was cleaned in the emergency department, a hematoma started to develop along the right jawline with brisk bleeding from the laceration site, and the patient was taken emergently to the operating room.
Result(s): The entire damaged segment of the ICA was stented with a Viabahn covered stent (Figs 1-3). Three segments of the right internal jugular vein (intracranial segment, neck segment, and intrathoracic segment) were imaged through the right femoral vein, which demonstrated no clots or extravasation. The wound was explored locally, and esophagogastroduodenoscopy and bronchoscopy were performed, showing no injury to the esophagus, larynx, or trachea. The patient recovered well without neurologic deficit. Carotid duplex ultrasound performed postoperatively demonstrated no hemodynamically significant flow disturbance in the right ICA.
Conclusion(s): The case demonstrates an opportunity for endovascular evaluation and management of traumatic vascular injury in zone 2 of the neck with close collaboration with trauma surgeons. [Figure presented] [Figure presented] [Figure presented]
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INTRODUCTION/BACKGROUND:Laparoscopic surgery is a viable treatment option for intrathoracic stomach (ITS); however, doubts have been raised regarding its efficacy. Routine use of mesh has been advocated. The aim of this study is to look at long-term objective and symptomatic outcomes after repair of ITS with selective use of mesh and fundoplication. MATERIALS AND METHODS/METHODS:A retrospective review of prospectively collected data was performed for patients who underwent surgical treatment of ITS from January 2004 to April 2009. ITS was defined as herniation of greater than 75% of the stomach into the chest on barium swallow. A standardized foregut symptom questionnaire was administered along with contrast study at 1, 3, and 5 years post surgery. RESULTS:Seventy-three patients with intrathoracic stomach were included in the study. Mean age was 70.6±10.4 (44-88) years, and two-thirds were females. There were 7 transthoracic and 66 transabdominal repairs (64 laparoscopic, 1 open, and 1 laparoscopic to open conversion). There was one intraoperative death, due to bleeding. Antireflux surgery was performed in 43 patients (20 Nissen, 18 Toupet, 1 Dor, and 4 Roux-en-Y gastric bypass (RNYGB)). Ten patients had Collis gastroplasty for short esophagus. Mesh was used in ten (13.7%) patients for crus reinforcement. Objective follow-up was available for 88%, 78%, and 92% patients at 1, 3, and 5 years, respectively. There were 5% (3/61), 11% (4/36), and 17% (2/12) radiological failures at these intervals. There was no significant difference in mean symptom and satisfaction scores or use of proton pump inhibitor (PPI) between patients with and without antireflux surgery. Mean satisfaction scores were 9.1, 9.0, and 9.0 at 1, 3, and 5 years, respectively. CONCLUSION/CONCLUSIONS:Laparoscopic repair of ITS with selective use of mesh and fundoplication is feasible, safe, and durable, resulting in a high degree of patient satisfaction.