Improved Survival in Children With Esophageal Perforation

Abstract

Morbidity and mortality are directly related to delays in diagnosis and therapy. Most cases of esophageal perforation in children can be closed primarily and the esophagus salvaged despite delayed presentation. The mortality rate in children with esophageal perforation (4%) is significantly less than that for adults (25%-50%).

Spontaneous pneumomediastinum in children

“…65,69 The signs potentially present on the chest radiograph were already described. The serious morbidity associated with esophageal perforation 65 means that this possibility must be eliminated by contrast radiography, preferably in the lateral decubitus position. 63 The choice of contrast medium is controversial.…”

“…19,45 The main differential diagnosis of SPM is spontaneous esophageal perforation (also called Boerhaave syndrome). 26 It is rare in children, 65 and occurs after violent vomiting or as a complication of an esophageal foreign body. 65±67 Clinical diagnosis is based on Mackler's triad, 68 i.e.…”

“…63 The choice of contrast medium is controversial. 62,65,69,70 One option is to use ®rst a watersoluble product, followed, if the ®ndings are normal, by a barium meal to improve sensitivity. 49,62,65,70 As this type of examination can miss 10±20% of lesions, 65 it can be combined with computed tomography.…”

“…62,65,69,70 One option is to use ®rst a watersoluble product, followed, if the ®ndings are normal, by a barium meal to improve sensitivity. 49,62,65,70 As this type of examination can miss 10±20% of lesions, 65 it can be combined with computed tomography. 71 Similarly, esophageal ®beroptic endoscopy (without insuf¯ation) can be used to diagnose esophageal perforation and to rule out the presence of a radiotransparent foreign body.…”

Chronic Pyriform Sinus-Pleural-Mediastinal Fistula Secondary to an Internal Penetrating Trauma by a Toothbrush

“…Later clinical manifestations with fever and local swelling may be indicative of retropharyngeal or parapharyngeal abscess or severe complications, such as mediastinitis, neck abscess or fistula, and pyriform sinuspleural-mediastinal fistula, where the prognosis is directly related to delays in diagnosis or management [6].…”