Esophageal Perforation in Children: Experience in Kurdistan Center for Gastroenterology and Hepatology/Iraq

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 pre-* Corresponding author. A. M. H. Hamawandi et al. 222 senting 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.

Button Battery Ingestion in Children: Experience in Kurdistan Center for Gastroenterology and Hepatology

“…There have been additional reported deaths measures such as total parenteral nutrition, nasogastric tube placement under fluoroscopy, anti-reflux medication, and intravenous antibiotics should be considered. Conservative management can be continued if radiographic evaluation suggests that the perforation is getting smaller [12]. If the perforation persists after several weeks or enlarges, surgical treatment should be considered [17,18].…”

“…When substantial esophageal erosion is detected, bronchoscopy may be performed to evaluate the tracheal wall, and a Gastrografin esophagogram will assist in evaluating for a perforation [11]. In the presence of a contained [12]. If the perforation persists after several weeks or enlarges or the patient deteriorates, surgical treatment should be considered [13].…”