Management of esophageal perforation secondary to caustic esophageal injury in children.
OBJECTIVE
To review our management of esophageal perforation in children with caustic esophageal injury.


METHODS
We reviewed the medical records of 22 children treated for esophageal perforations that occurred secondary to caustic esophageal injury.


RESULTS
There were 18 boys and 4 girls (mean age, 5 years; range, 2-12 years). Three children were treated for perforation during diagnostic endoscopy and 19 were treated for a collective 21 episodes of perforation during balloon dilatation. One child died after undergoing emergency surgery for tracheoesophageal fistula and pneumoperitoneum. Another patient underwent esophagostomy and gastrostomy. Twenty patients were treated conservatively with a nasogastric tube, broad spectrum antibiotics, and tube thoracostomy, 16 of whom responded but 4 required esophagostomy and gastrostomy. Although the perforation healed in 21 patients, 20 were left with a stricture. Two children were lost to follow-up, 8 underwent colonic interposition, and 10 continued to receive periodic balloon dilatations. Two of these 10 patients underwent colonic interposition after a second perforation. The other 8 became resistant to dilatations: 4 were treated by colon interposition; 2, by resection and anastomosis; and 2, by an esophageal stent.


CONCLUSIONS
Esophageal perforation can be managed conservatively. Because strictures tend to become resistant to balloon dilatation, resection and anastomosis is preferred if they are up to 1 cm in length, otherwise colonic interposition is indicated.
Eliçevik
Mehmet
M
Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Atakoy, Istanbul, Turkey.
Alim
Altan
A
Tekant
Gonca Topuzlu
GT
Sarimurat
Nuvit
N
Adaletli
Ibrahim
I
Kurugoglu
Sebuh
S
Bakan
Mefkur
M
Kaya
Güner
G
Erdogan
Ergun
E
D002057:Burns, Chemical / Q000175:diagnosis / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D002424:Caustics / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004939:Esophageal Perforation / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D002424:Caustics