Esophageal rupture in a child after vertical expandable prosthetic titanium rib expansion thoracoplasty: first report of a rare complication.
METHODS
Case report and clinical discussion.


OBJECTIVE
To illustrate the significance of esophageal rupture as a rare complication after expansion thoracoplasty with implementation of a vertical expandable prosthetic titanium rib (VEPTR).


BACKGROUND
Chest wall deformities and secondary scoliosis are rare complications after a repair operation for esophageal atresia. The new technique of VEPTR expansion thoracoplasty directly treats the chest wall deformity and indirectly corrects the scoliosis. We describe a patient with an esophageal rupture after VEPTR expansion thoracoplasty.


METHODS
We report the case of an 11-year-old boy who developed a progressive scoliosis caused by fused ribs after multiple reoperations for esophageal atresia. The patient was treated operatively by an expansion thoracoplasty via an opening wedge thoracostomy with implementation of two VEPTRs.


RESULTS
After surgery, the patient developed a respiratory insufficiency because of rupture of the esophagus. The complication was treated conservatively. A second operation was needed to remove an infected VEPTR. The patient fully recovered after this severe complication.


CONCLUSIONS
To our knowledge, this is the first report of esophageal rupture after VEPTR expansion thoracoplasty. This promising new technique treats scoliosis in patients with severe chest wall deformities. When a patient presents with fused ribs and there is a history of esophageal atresia, we should keep in mind that the esophagus is at risk of rupturing during the scoliosis correcting procedure.
Department of Orthopedics, Isala Clinics, Zwolle, The Netherlands. s.n.van.vendeloo@isala.nl
Stefan
S
van Vendeloo
Kees
K
Olthof
Jan
J
Timmerman
Adriaan
A
Mostert
D002648:Child; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections; D012086:Reoperation; D012272:Ribs / Q000002:abnormalities / Q000601:surgery*; D012421:Rupture / Q000209:etiology* / Q000473:pathology; D012600:Scoliosis / Q000601:surgery; D013905:Thoracoplasty / Q000009:adverse effects*; D014025:Titanium; D016896:Treatment Outcome
D014025:Titanium