title: Management of esophageal perforation secondary to caustic esophageal injury in children.
abstract: 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.
authors: Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Atakoy, Istanbul, Turkey.
authors: Mehmet
authors: M
authors: Eliçevik
authors: Altan
authors: A
authors: Alim
authors: Gonca Topuzlu
authors: GT
authors: Tekant
authors: Nuvit
authors: N
authors: Sarimurat
authors: Ibrahim
authors: I
authors: Adaletli
authors: Sebuh
authors: S
authors: Kurugoglu
authors: Mefkur
authors: M
authors: Bakan
authors: Güner
authors: G
authors: Kaya
authors: Ergun
authors: E
authors: Erdogan
mesh_terms: 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
chemical_list: D002424:Caustics