Abstract
Background: Esophageal perforation is a rare, but potentially life threatening injury. The etiology and management of this condition have changed overtime. Iatrogenic causes are increasingly recognized and management is evolving towards more conservative approaches. Objective: To review our experience in the management of esophageal perforation in pediatric patients. Patients and methods: This retrospective study was conducted in the Kurdistan center for gastroenterology and hepatology in Sulaimani city. Review of records for cases of esophageal perforation during the period from January 2006 to October 2013 was performed. Results: Ten cases were found to have esophageal perforation. The causes of esophageal perforation were complications of endoscopic dilation for esophageal stricture (n = 7), button battery ingestion (n = 2), complication of esophagoscopy for corrosive injury (n = 1). The mean age was 42 months (range, 18 - 75 months). The diagnosis was made during the procedure in 6 cases, within 12 hours in 2 cases and late in the two cases of battery ingestion. Subcutaneous emphysema and respiratory distress were the main presenting features. The location of perforation was thoracic in 9 cases and cervical in 1 case. Conservative management was successful in 7 patients and surgical closure was done in two patients. One death has been reported. Conclusion: Iatrogenic causes were the most common causes of esophageal perforation. Conservative management with interventions guided by clinical response can have a favorable outcome and may become the best initial treatment strategy in the future. Further larger scale studies are recommended to establish the best protocol for conservative management.
Highlights
Esophageal perforation (EP) is a rare, but it is a potentially life threatening injury that can quickly lead to the development of mediastinitis, sepsis, and possible multiorgan failure in the absence of prompt recognition and treatment [1]
Conservative management with interventions guided by clinical response can have a favorable outcome and may become the best initial treatment strategy in the future
Further larger scale studies are recommended to establish the best protocol for conservative management
Summary
Esophageal perforation (EP) is a rare, but it is a potentially life threatening injury that can quickly lead to the development of mediastinitis, sepsis, and possible multiorgan failure in the absence of prompt recognition and treatment [1]. Primary repair of esophageal perforations is becoming widely accepted as the treatment of choice, and several studies have demonstrated respectable mortality and morbidity rates with benign perforations, even with delayed presentation. As the incidence of EP increases with the advancement of invasive endoscopic procedures, early recognition of clinical features and implementation of effective treatment are essential for a favorable clinical outcome with minimal morbidity and mortality [7]. Several options exist for managing the various types of esophageal perforations has prompted several authors to review their experience with this challenging and potentially deadly entity [5]-[7]. The aim of this study was to review our experience in the management of EP and the outcome of such management in pediatric patients
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