Use of a self-expanding metal stent to treat acute esophageal perforation in a 4-year-old child

Abstract

Esophageal perforations are associated with a high morbidity and mortality in the pediatric population. Most cases are managed conservatively with antibiotics, nutritional supplementation, and percutaneous drainage of fluid collections. Direct surgical repair is reserved for patients with hemodynamic instability or evidence of clinical worsening due to the high risk of postoperative complications. Utilization of stents in the treatment of acute esophageal perforation has become well-established in adults, but evidence remains lacking in the pediatric population. We present the case of a 4-year old male with an acute esophageal perforation who was successfully treated with an esophageal self-expanding metal stent (SEMS) in lieu of direct surgical repair. He failed extubation on postoperative day (POD) 6 due to tracheal compression by the oversized stent but exhibited good healing with successful extubation on POD 13. This case report demonstrates that esophageal stents may be a promising alternative to surgical repair in the pediatric population. Further studies and trials should be performed to compare the effectiveness of esophageal stenting to direct surgical repair. Modification and downsizing of the adult SEMS design for pediatric anatomy is recommended to prevent complications such as tracheal compression and prolonged intubation.