Iatrogenic esophageal perforation in children: Patterns of injury, presentation, management, and outcome

Approach and management modalities in Esophageal Perforations

“…Vomiting of severe nature associated with acute pain suggest spontaneous. [13][14][15] Spontaneous rupture may follow any straining effortlabour, asthma, blunt trauma etc. When in addition, there is cervical subcutaneous emphysema, the term Mackler's triad is used.…”

“…Otherwise the death rate was 70% or more among those who were not operated. [12][13][14][15][16][17] In the present era, conservative management has been considered in cases due to iatrogenic causes, patients who are found to be stable hemodynamically, and patients showing lesser degree of contamination of the perforation. 2 Of late, non-operative management is being advocated, more so in pediatric population, because at younger age, tissues have high healing capacity.…”

“…Thus, they proved that even among children, conservative management can be adopted. 13 In corrosive perforations among children conservative management with or without cervical esophagostomy and gastrostomy works nicely with relatively lesser mortality and morbidity. 23 It was found in review that esophagectomy is better than conservative approach and even better that the primary repair.…”

“…[7][8][9][10] In case the diagnosis of perforation is made within 24 hours, the treatment of choice is primary closure of the perforation site and wide drainage of the mediastinum. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis.…”

“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Esophageal perforations are dramatic complications and if managed improperly result in mortality. Proper management requires an appreciation of the anatomy, the etiology and the pathophysiology of this entity.…”