Caustic Stricture Research Articles

Caustic esophageal stricture from diagnosis untill cure

Background: The diagnosis of esophageal stricture after caustic ingestion is based on clinical symptoms of dysphagia, regurgitation and chocking that is evident initially in the acute stage. These symptoms may ameliorate by time or proceed to evident stricture due to fibrosis. This will need either dye esophagogram or Esophagoscopy which is better to be done not before the lapse of at least 6 weeks from injury. Esophageal dilatation using wire-guided dilators is the cornerstone of treatment. The frequency of dilatation is based on recurrence of dysphagia and in multiple strictures, repeated sessions with multi-level injection of steroids and graded dilatation is needed. Failure of dilatation or occurrence of complications may necessitate esophageal replacement and usually we prefer the transverse colon based on the left colic vessels in retrosternal position to treat the condition. We aimed to review the management of caustic esophageal strictures based on what is known and adding our experience in this aspect. Methods: We reviewed the articles discussing management of caustic esophageal strictures in the last twenty years. We added our experience of more than forty years managing an average of thirty new cases every year. Results: Management of caustic esophageal strictures has changed in the last years. Advanced endoscopic techniques of dilatation reduced the need for esophageal replacement. Conclusions: Caustic esophageal strictures could be managed successfully with advanced techniques of endoscopic dilatation. Keywords: Caustic stricture; esophageal dilatation; esophagoscopy; esophageal replacement

Iatrogenic esophageal perforation caused by endoscopic dilatation of caustic stricture: Current management and possibility of esophageal salvage

BackgroundIatrogenic esophageal perforation (EP) is an undesirable complication of endoscopic dilatation of caustic esophageal stricture. We reported our current management protocol with possibility of continuing the dilatation program. Patients and methodsFrom January 2009 to January 2020 medical records were reviewed for patients presented with iatrogenic EP. Management according to each case condition was reported. Results24 patients were enrolled, aged from 1.5 to 6 years old. Perforation was cervical in one case, abdominal in two cases, and thoracic in 21 cases. Immediate surgical repair was performed in the abdominal cases. Conservative management was chosen in 22 cases; two cases didn't respond and underwent esophageal diversion, and one of them died owing to severe sepsis. Three patients refused another trial of dilatation. Two cases failed to be redilated. 17 patients continued a dilatation program. Time passed between perforation and redilatation ranged from 35 days to 7 months. 15 patients were cured completely from dysphagia, one patient had marked improvement of his dysphagia, and one case with a resistant stricture was referred for esophageal replacement. ConclusionPreserving the native esophagus is possible after iatrogenic EP of caustic esophageal stricture. A conservative approach should be attempted with caution not to endanger patient's life.Level IV of evidence

Laparoscopic-assisted gastric pull-up: initial experience and technical details

To describe our initial experience in laparoscopic-assisted gastric pull-up via posterior mediastinal route in comparison with our historic experience performed by open laparotomy gastric pull-up via retrosternal route. The results of the two approaches were evaluated in this study. Between 2000 and 2017, we conducted a retrospective review of all patients that had undergone gastric transposition for esophageal atresia (EA) and long caustic strictures when preservation of the native esophagus was not possible. A total of 17 pediatric patients underwent gastric pull-up transposition as esophageal replacement technique. The patients were divided into two groups. Group A (2000–2015) consisted of 11 patients that underwent open laparotomy gastric pull-up via the retrosternal route. Three Group A patients had EA Type I, two had EA Type II, five had EA Type III, and one long caustic stricture. Associated anomalies included VACTERL association in two cases, Down syndrome in one case and intestinal malrotation in one case. The mean age at surgery was 2.2 years and the mean follow-up was 9.3 years. All patients were able to achieve oral feeds. Group B (2016–2018) consisted of six patients that underwent laparoscopic-assisted gastric transposition via posterior mediastinal pathway. Three had EA Type I, two had EA Type III, and one had a long caustic esophageal stricture. Associated anomalies included a single case of VACTERL association. Previous surgeries included two thoracotomies and two esophagostomies in patients with EA/TEF and one gastro-jejunal anastomosis in a patient with pyloric total disconnection after pyloric balloon dilatation for caustic esophageal and pyloric stricture. All patients underwent gastrostomy. Laparoscopic procedure was successfully completed in all patients without conversion. The mean follow-up in Group B was 27 months. All patients were able to establish oral feeds. Laparoscopic-assisted gastric pull-up as esophageal replacement technique is safe and has few complications. Slight modifications of the technique such as pyloric dilation reduce laparoscopic surgical time.

MicroRNA expression profiles in the esophagus of children with caustic stenosis: A pathway towards esophageal cancer?

BackgroundEighty percent of caustic ingestions occur in children and esophageal neoplasms may develop as a late complication of such injury. The identification of biomarkers is a promising strategy to improve early diagnosis of esophageal cancer or caustic lesions that are at an increased risk of progression. Study design/aimsThis study aimed at identifying global microRNA (miRNA) expression changes in esophageal mucosa from children with caustic stenosis. The study included 27 biopsy samples from 15 patients. Samples were divided into two groups, according to the time elapsed after injury (N = 15 in Group A, with less than five years of follow-up and N = 12 in Group B, with more than five years of follow-up). miRNA expression profiles were determined in each lesion, compared with normal esophageal tissues from control group. We used the TaqMan Human MicroRNA Arrays (Thermo Fisher) platform. Furthermore, bioinformatic algorithms were used to identify miRNA target genes and biological pathways including miRNAs and their target genes potentially associated with esophageal disease. ResultsThirteen miRNAs were significantly deregulated (9 over- and 4 underexpressed) in patients from Group A. In patients from Group B, two miRNAs were over- and two were underexpressed. Of note, miR-374 and miR-574 were deregulated in Group B patients and have been linked to esophageal tumorigenesis. We identified signal transduction and transcription factor networks with genes strongly related to development and progression of esophageal cancer. ConclusionmiRNAs identified here contribute to a better understanding of pathways associated with malignant transformation from caustic stenosis to neoplastic lesions. This study may serve as a basis for validation of miRNAs, including miR-374 and miR-574, as potential biomarkers of early cancer detection.

Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study

Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BESs). This study aimed to establish risk factors for refractory BESs and assess long-term clinical outcomes of ED. We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BESs. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BESs, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints were time from first to last ED session and adverse events. Dilation up to 13 to 15mm was associated with a higher number of ED sessions than dilation up to 16 to 18mm (5.0 vs 4.1; hazard ratio [HR], 1.4; P= .001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR, 2.1; P< .001), radiation (5.0 vs 3.6; HR, 3.0; P< .001), caustic (7.2 vs 3.6; HR, 2.7; P< .001), and postendotherapy (3.9 vs 3.6; HR, 1.8; P= .005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy, and 62% in caustic strictures. Esophageal perforation occurred in 23 ED sessions (.4%) in 22 patients (2.4%). More than 60% of patients with BESs remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16mm to reduce the number of ED sessions in these patients.

Esophageal caustic stenosis – difficulties of therapeutic management

Esophageal stenosis is one of the most common sequels of caustic injury. After the ingestion, in the acute phase, the life support is sometimes critical, and the treatment varies from observation to esophagectomy. During the first 6 months, endoscopic dilation can be necessary in order to maintain the patency of the esophageal lumen.&#x0D; Usually, endoscopic dilation is the treatment of choice for caustic stenosis of the esophagus. Sometimes this procedure is not possible or too risky and then reconstruction surgery is needed, but no earlier than 6 months.&#x0D; We present the case of a 57 years old male who was referred to our clinic for the treatment of a mid-esophageal caustic stenosis, after the accidental ingestion of a concentrated alkaline substance 6 months before. After an initial successful endoscopic dilation, in the second attempt, due to the asymmetric position of the stenosis and the high risk of perforation, we decided to perform an esophageal by-pass. We chose to use the left colon for interposition, with the left branch of middle colic artery as the feeding source and the sigmoid trunk as the second arcade. The surgical procedure went uneventful, with restoration of normal oral feeding.

1733 Wonder Neutralization: Esophageal Stents in Caustic Injury

INTRODUCTION: Introduction Common causes for benign esophageal strictures (ES) are post -surgery, caustic ingestions and radiation therapy. Caustic strictures of the gastrointestinal tract can be a challenge to treat even after multiple endoscopic treatments due to its inherent relapsing nature. We report here our experience with self-expandable metallic stents (SEMS) in a patient with corrosive stricture of the esophagus. CASE DESCRIPTION/METHODS: Case A 25-year-old female with 2-year history of refractory ES due to caustic injury presented for endoscopic treatment. Patient had multiple endoscopic dilation attempts in past. Pediatric gastroscope showed esophageal stricture starting at 20 cm from the incisors however it could not traverse through the stricture. Under fluoroscopic guidance a 0.035 in x 260 cm guidewire was placed in the stomach. The proximal end of stricture was occluded by biliary 8.5 mm stone extraction balloon and contrast was injected through balloon catheter under fluoroscopy guidance showing 12 cm long significantly narrowed ES. A 18 mm × 103 mm fully covered esophageal metal stent (FCEMS) was placed under fluoroscopic guidance keeping the distal end of the stent above the gastroesophageal junction. Four days later, follow up EGD showed previously placed FCEMS was patent and widely open. The distal end of the stent was at 27cm and GEJ was at 35cm from entry point. Under fluoroscopic imaging and wire guidance another FCEMS (18 mm × 153 mm) was placed successfully to treat the left-over portion of the stricture below the previously placed stent. The second stent was deployed with in the first stent with its distal end at GEJ. Post stent placement, endoscopic and fluoroscopic imaging’s were satisfactory. At 2 weeks follow up, patient revealed significant improvement in her symptoms and ability to tolerate soft diet. DISCUSSION: Discussion ES secondary to caustic injury tend to require multiple dilation procedures, multiple hospitalizations with associated risks and cost, affecting patient’s quality of life. There is a need for novel therapeutic strategies that will provide a long-term solution. Our case highlights the growing interest and utility of multiple FCEMS in the treatment of severe and long ES. The deployment of multiple FCEMSs in our patient with long history of ES related dysphagia dramatically improved her symptoms and patency of esophagus.

Physiologic type reconstruction in upper gastrointestinal caustic strictures

The authors discuss their experience in the surgical treatment of caustic stenosis in the upper gastrointestinal tract. They present operative solutions using isoperistaltic transverse colonic segment in oesophageal stenosis caused by gastric outlet obstruction, or when these two presented together. Further indications for the above were bronchial or tracheo-oesophageal fistulas and oesophageal perforation. Late adaptation of the colonic grafts were measured by radiokinematography and histochemistry. The overall morbidity was 4.9%. Postoperative salivary fistulas closed spontaneously. Late postoperative complications (13.5%) were treated successfully. The multihaustral motility of the graft prevented the reflux, while the altered mucopolysaccharides of the colonic mucosa prevented the ulcer formation. Orv Hetil. 2019; 160(16): 613-618.

Caustic stenosis of mid esophagus, late rehabilitation in a six years old girl

Caustic stenosis of mid esophagus, late rehabilitation in a six years old girl

Four Year Results of Conservative Treatment of Benign Strictures of the Esophagus with Savary Gilliard Technique of Bougienage: Cross-Sectional Study Representing First Experiences in Republic of Macedonia.

Abstract Background: Benign esophageal strictures are complications resulting from various causes. They can be structurally categorized in two groups: simple and complex. Treatment is similar in most cases that require dilatation and means use of three general types of dilators that are currently in use. However, despite the last guidelines on esophageal dilatation, the therapeutic response, optimal timing of treatment and interval between sessions may vary and there is no strong consensus in the literature regarding this fact. Aims: To analyzethe first 4 year experience of Digestive Endoscopy Unit at the University Clinic of Gastroenterohepatology of the Medical Faculty, Skopje, Republic of Macedonia in treating benign esophageal strictures, since the Savary-Gilliard technique of “bougienage” was introduced for the first time in Republic of Macedonia, at our Institution, in December 2013, by assessing etiology, length of stricture, number of dilations required to achieve satisfactory therapeutic response, as well as the relationship between the type, extent of stenosis and therapeutic response. Methods: One hundred and forty five dilations, during a period from 20th December 2013, until March 2017, have been analyzed in 31 patients Results: The caustic strictures were the most prevalent, occurring in 15 (48%) of patients, followed by peptic stenosis presenting 26% of patients. The long and corrosive strictures needed more sessions to the absence of dysphagia. Peptic and short stenoses best respondedon treatment and needed fewer dilatation sessions per patient. Conclusion: Caustic stricture is the most common type of benign esophageal stenosis and the most refractory to treatment, especially the long one. Peptic stenosis is the second cause of benign esophageal strictures and responded well to endoscopic therapy. The higher the extent of stenosis, the greater the number of sessions required. Short strictures have good prognoses in most cases. The number of dilations depended directly on the cause and extent of stenosis. Bouginage using Savary-Gilliard or American type of technique, irrespective of the type and the extent of esophageal stenosis, is safe and purposeful procedure.

Endoscopic mucosal autograft for treating esophageal caustic strictures: preliminary human experience.

Esophageal caustic stricture is a stubborn disease and postoperative restenosis limits the clinical efficacy of endoscopic dilation. Autologous mucosal grafts have been successfully applied in the treatment of urethral stricture and in the prevention of stricture after extensive mucosal resection. We aimed to use mucosal autografting performed endoscopically to treat refractory esophageal stricture. METHODS : Three patients with intractable corrosive esophageal stricture were treated endoscopically by combining dilation with autologous mucosal transplantation. RESULTS : All procedures were successful with no severe complications. Mucosal regeneration was shown at the transplanted segments. One patient was able to maintain a normal diet with complete remission after 1year of follow-up. Intraluminal stenosis and dysphagia were significantly improved in another two patients. CONCLUSIONS : Mucosal autografting can achieve esophageal re-epithelialization, inhibit undesired fibrosis, prevent restenosis, and promote functional regeneration.

Thoracoscopic vagal-sparing esophagectomy and colonic interposition for caustic stricture.

Minimally invasive esophagectomy is an increasing trend in surgery. Thoracoscopic esophagectomy is applicable and an alternative procedure to conventional esophagectomy in patients especially with end-stage benign diseases like caustic stricture. A 33-year-old female patient was admitted to the department of general surgery with dysphagia. The patient was suffering from caustic stricture due to ingestion of hydrochloric acid. A totally thoracoscopic and laparoscopic vagal-sparing esophagectomy and colonic interposition was performed. As a more physiologic alternative, vagal-sparing esophagectomy is the ideal operation for these patients.

Su1665 - Microrna Expression Profile in Esophagus of Children with Caustic Stenosis: A Novel Biomarker for Early Esophageal Cancer Detection?

Su1665 - Microrna Expression Profile in Esophagus of Children with Caustic Stenosis: A Novel Biomarker for Early Esophageal Cancer Detection?

Self-dilation for therapy-resistant benign esophageal strictures: towards a systematic approach

BackgroundPatients with therapy-resistant benign esophageal strictures (TRBES) suffer from chronic dysphagia and generally require repeated endoscopic dilations. For selected patients, esophageal self-dilation may improve patient’s autonomy and reduce the number of endoscopic dilations. We evaluated the clinical course and outcomes of patients who started esophageal self-dilation at our institution.MethodsThis study was a retrospective case series of patients with TRBES who started esophageal self-dilation between 2012 and 2016 at the Academic Medical Center Amsterdam. To learn self-dilation using Savary-Gilliard bougie dilators, patients visited the outpatient clinic on a weekly basis where they were trained by a dedicated nurse. Endoscopic dilation was continued until patients were able to perform self-bougienage adequately. The primary outcome was the number of endoscopic dilation procedures before and after initiation of self-dilation. Secondary outcomes were technical success, final bougie size, dysphagia scores, and adverse events.ResultsSeventeen patients started with esophageal self-dilation mainly because of therapy-resistant post-surgical (41%) and caustic (35%) strictures. The technical success rate of learning self-bougienage was 94% (16/17). The median number of endoscopic dilation procedures dropped from 17 [interquartile range (IQR) 11–27] procedures during a median period of 9 (IQR 6–36) months to 1.5 (IQR 0–3) procedures after the start of self-dilation (p < 0.001). The median follow-up after initiation of self-dilation was 17.6 (IQR 11.5–33.3) months. The final bougie size achieved with self-bougienage had a median diameter of 14 (IQR 13–15) mm. All patients could tolerate solid foods (Ogilvie dysphagia score ≤ 1), making the clinical success rate 94% (16/17). One patient (6%) developed a single episode of hematemesis related to self-bougienage.ConclusionsIn this small case series, esophageal self-dilation was found to be successful 94% of patients when conducted under strict guidance. All patients performing self-bougienage achieved a stable situation where they could tolerate solid foods without the need for endoscopic dilation.

Caustic Gastric Stenosis in Adults

Introduction: Caustic gastric stenosis is relatively rare complications after voluntary or accidental ingestion of caustic substances.Methods: They analyzed all the medical recordings of the patients operated in First Surgical Clinic, “St Spiridon” Emergency Hospital Iasi during 2004-2017 (6 cases - lot A) for caustic gastric stenosis presented comparatively with a lot of 46 patients with caustic gastric stenosis (lot B) operated in the same clinic between 1990 and 2003.Results: The most frequently used substance was the caustic soda in group B and detartrant (surface cleaning product – a descaling agent) in group A. The most common site of stenosis was antral, prepyloric; this is explained by the prolonged contact of the caustic with this declivity area and by the spasm of the ankle muscles secondary to caustic action. In the period of establishment of esophageal and/or gastric stenosis, in all cases of group A, esophageal dilation with endoscopic pneumatic balloon probe was started early for both esophageal and gastric stenosis and in group B only in 19 cases. Surgical treatment depended on the extent of the corrosive lesions. In most cases, with limited antral stenosis, we performed distal gastrectomy with gastroduodenal anastomosis. In the combined lesions (esophageal and gastric stenosis) we preferred surgical interventions in two or three steps.Conclusion: Associated gastric and esophageal lesions form a distinct subgroup that often requires complex surgical resolution through laborious procedures. It is advisable to perform endoscopic dilation procedures, both esophageal and pyloric lesions, before attempting surgical treatment. Postoperative morbidity and mortality decreased over the time, through a personalized, differentiated approach to each case, into a multidisciplinary team.

Late Complications of Colon Interposition for Esophageal Reconstruction

Introduction: Successful restoration of digestive continuity following esophagectomy is a challenge. Gastric graft remains is the first option to reconstruct diseased esophagus. However, colon graft is preferable in some instances. Colon interposition is a complex and more demanding surgical procedure. The long-term functional results of colon interposition were satisfactory and can be subsequently affected by late complications. We reported in this retrospective study, the late complications occurred after left colon interposition performed for esophageal caustic stricture from 2000 to 2016. Patients and Methods: Sixteen of 107 patients who received left colon interposition for esophageal caustic stricture developed a late complication. There were 15 women and one man with median age of 20 years. Three patients had a previous cervical leak and thoracic inlet was widened in 2 cases. Results: The late post-operative morbidity rate was 14.9%. Cervical anastomotic stricture occurred in 8 patients. Dilations were successful in 6 patients and surgical revision was required in 2 patients. Symptomatic mild gastrocolic reflux occurred in 5 patients and Symptoms improvement had been obtained after medical treatment and lifestyle modification. Two patients developed graft redundancy and surgery was required after failure of life-style modification measures. It consisted of resecting the redundant colon and performing an end-to-end anastomosis. Conclusion: Late complication after colon interposition can greatly affect swallowing function and quality of life. Surgery is required in some conditions to improve symptoms and life-quality. Identification of predisposing factors and improvement in technique remain the best way to reduce the risk of late complications.

Conduits for esophageal replacement: alternatives

Background: Native esophageal replacement after esophageal resection is a problem that has challenged the surgeons over a century. Conduit must be long enough to bridge between cervical esophagus and abdomen. It must have reliable vascular supply, so that it can perform its function of deglutition. Stomach, colon and jejunum all these are used since long. However, there are times when the stomach is unavailable for use as a conduit. It is in these instances that an esophageal surgeon must have an alternative conduit in their armamentarium. Present study is aimed to discuss technical aspects of stomach, colonic, interposition in 32 cases of benign and malignant pathology, we review recent literature with a focus on outcomes, advantages and disadvantages of all options.Methods: A retrospective study of 32 cases between 2009 to 2016 at teaching institute in central India. 32 cases of benign and malignant esophageal disease needing esophageal resection and replacement. The record of each patient was reviewed for age, gender, indication for esophageal resection, type of operation, indication for selection of conduit, morbidity and mortality. The patient’s gastrointestinal symptoms were graded as excellent, good, fair or poor. Survival was estimated by the Kaplan-Meier method using the date of operation as the starting point.Results: Study includes 24 males and 8 females, 25 cases cancer esophagus with 6 patients caustic stricture, 1 patient had radiation stricture. Gastric conduit was used in 29 patients while 3 patients had colonic interposition. No complications noted in colonic group, while cervical anastomotic leak along with cardiovascular and respiratory complications noted in 6 patients. Gastric replacement was less time consuming than colonic interposition. There was hospital mortality of 4 patients. There is no difference in survival of these patients whether you use gastric or colonic conduit.Conclusions: Clinical decision making in the treatment of esophageal cancer consists of balancing the risks of a particular treatment against potential benefits gained in survival and quality of life. The choice of conduit for reconstruction may have significant impact on the quality of life. Stomach is the most commonly used organ for replacement but when it is not available then colon can safely be used as an esophageal replacement.

Total esophageal substitution for combined hypopharyngeal and esophageal strictures after corrosive injury in children

Background/purposeThe treatment of children with esophageal strictures and involvement of the hypopharynx caused by caustic substance ingestion continues to be challenging. The aims of the present study are to describe the peculiarities of the technique of complete esophageal substitution for the treatment of children with severe caustic strictures (pharyngocoloplasties) and to compare the results to those of classical esophagocoloplasty with thoracic and abdominal esophageal substitution in another group of children. MethodsA total of 258 children underwent colon interposition for esophageal replacement. Among these patients, 19 had complex esophageal caustic strictures involving the high level of the esophagus and hypopharynx without response to endoscopic dilatations. This group was compared with another group who required partial esophagocoloplasty with intact hypopharynx and high esophagus (239 patients). For the pharyngocoloplasty procedure, the transverse and great parts of the right colon were the segments selected for interposition and were maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade via the sigmoid vessels. ResultsIn the pharyngocoloplasty group, 9 patients (47.4%) presented with cervical anastomosis stenosis with episodes of aspiration pneumonia, although good responses to endoscopic dilatation treatments were observed. All patients survived. In the esophagocoloplasty group, the main complications were cervical leaking (18.0%) and stenosis (16.7%). Statistical comparisons revealed that the pharyngocoloplasty patients exhibited a lower incidence of cervical leakage and increased incidences of cervical stenosis and aspiration pneumonia, although all patients could swallow normally. ConclusionPharyngocoloplasty with complete esophageal substitution is a safe and effective procedure for the treatment of esophageal caustic strictures with severe stenoses reaching the hypopharynx that are refractory to previous endoscopic treatment. Level of evidenceII

Esophageal Replacements for Caustic Esophageal Stenosis in Adults about 9 Cases in Ouagadougou

Objective: To report our experience of the esophageal plasty for caustic stenosis of the esophagus. Methods: Retrospective study of caustic stenosis of the esophagus in patients aged over 15 years, operated in Ouagadougou from 2008 to 2016. Nine patients were operated. Patients ranged in age from 25 to 53 years. Caustic ingestion was voluntary in 6 cases. Psychiatric disorders were confirmed in one case. The type of surgery and the postoperative evolution were analyzed. Results: In 6 patients the plasty was preceded by a gastrostomy or a feeding jejunostomy. The transplant, always placed in retro sternal position, was colic in 8 cases and gastric in one case. The evolution was marked by the occurrence of a cervical fistula in 5 cases, postoperative peritonitis in 2 cases, parietal suppuration in 2 cases and pneumothorax in 3 cases. One case of death was noted. After a follow-up of 6 months to 9 years, we noted a case of dysphagia. Conclusion: Esophageal plasty is a saving gesture that restores normal nutrition to the patient. It deserves to be promoted.

Management of Women Infertility in Tropical Africa: The Experience of the Gynecology Department of University and Hospital Center of Treichville (Abidjan-Cote d’Ivoire)

Objectives: This study aimed to clarify the etiology of women infertility and describe their management in our service with limited technical equipment. Methodology: We conducted a retrospective and descriptive study on 175 women treated for infertility and followed in the gynecology services of the university Hospital center of Treichville from 1st January 2012 to 31st December 2014. Results: During the study, we recorded 12072 consultations in gynecology including 1582 (13.1%) cases of infertility, but only 175 cases were selected for this study. The patients had an average age of 31.3 years and an average socio-economic level in general (78.9%). The etiologies were found in 79.4% of patients, dominated by classical abnormalities: uterine (fibroids: 41.8%), hormonal, tubo peritoneal (5%). We also found some unusual pathologies related to cultural practices (female genital mutilation, caustic stenosis of the vagina). The surgery was performed in several patients, including myomectomy by laparotomy (46.6%), laparoscopy, hysteroscopy and vaginal surgeries. As to drug treatment, they were various combinations, and the ovarian stimulation practices (62.3%) and induction of ovulation (47.2%) were common. The result of this support has been marked by the occurrence of 74 pregnancies (42.3%), with the birth of healthy children in the majority of cases (95.9%). Conclusion: The management of infertile women was frequent and yielded encouraging results despite our limited technical equipment.