Abstract
Management of delayed presenting esophageal perforations has long been a topic of debate. Most authors consider definitive surgery being the management of choice. Management, however, differs in pediatric patients in consideration with better healing of younger tissues. We extensively review the role of aggressive non-operative management in pediatric esophageal perforations, especially with delayed presentation and exemplify with case of a young boy with esophageal perforation and esophago-cutaneous fistula. We also lay down the protocol to manage such patients based on our institutional recommendations.
Highlights
Management of esophageal perforations (EPs) has long been a topic of debate
The management protocols are governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation
We review the literature on the role of non-operative management in EPs and describe management of a pediatric case with delayed traumatic thoracic EP with esophago-cutaneous fistula
Summary
Management of esophageal perforations (EPs) has long been a topic of debate. The management protocols are governed by symptom severity, perforation site, time elapsed since perforation and cause of perforation. Non operative management is generally advocated in contained leaks, iatrogenic injuries and hemodynamically stable patients It is not recommended in delayed EPs (presenting after 24 hours) [5]. Early surgical intervention (within 24 hours of presentation), with intent of definitive repair, used to be the mainstay of treatment owing to the reported mortality rates as high as 69% in patients managed non-operatively or in whom surgeries were delayed. First published account of successful non operative management for EPs came from work of Mengoli and Klassen in 1965 They achieved mortality rates of about 6% in 18 cases of iatrogenic esophageal perforations (following diagnostic or therapeutic esophagoscopy) managed conservatively.
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