Esophageal cutaneous fistula, complication from penetrating neck trauma caused by air shotgun in pediatric patient

Abstract

Penetrating neck trauma are uncommon in the pediatric population, but they constitute a significant management challenge. An air shotgun remains a significant source of injury to children. It causes severe damage and can involve the brain, eyes, heart, abdomen, and other body parts. Penetrating neck wounds account for almost 20% of firearm-related injuries in children and adolescents. Esophagus injury happened 9.6% of children with non-intracranial firearm injury. A 3 -years-old boy referred from secondary level hospital by dr. Soetomo General Hospital with a history of accidently shot by an air shotgun at the neck area. Patient underwent two surgeries in a second level hospital. First surgery was removing the bullet. The second surgery was indicated due to complications of subcutis emphysema. Because the drain production was milk, the patient was referred to our hospital. We suspected there were a esophageal cutaneous fistula. Patient was admitted and managed conservatively with IV fluids, IV antibiotics, adequate wound care, and surgical nutritional care by gastrostomy feeding. After one week, the patient was discharged from hospital. Patient is having a diet from gastrostomy feeding and is scheduled to take esophagogram evaluation. Esophagus injury in penetrating neck trauma by air shotgun in pediatric is a rare case, the esophageal cutaneous fistula as complications is even rarer. We conclude that they can be successfully managed by an active nonoperative approach. A good antibiotic coverage, nutritional support, adequate wound care, limited surgical interventions like gastrostomy are vital and may be induced secondary healing to close the fistula.