Management of pediatric esophageal perforation

A case of extrapleural empyema

“…3 van der Zee et al reported an extrapleural abscess secondary to a paediatric oesophageal perforation. 4 Gumbiner et al reported an extrapleural effusion of retropharyngeal origin. 5 In cases of unexplained upper thoracic extrapleural effusion or a widened mediastinum, it is important to search for retropharyngeal abscess even in the absence of dysphagia, dyspnoea, or swelling of the posterior pharyngeal wall.…”

Conservative Therapy of Esophageal Perforation With Neck Abscess in a Child

“…Furthermore, it has been suggested that the mediastinum of children is relatively resistant to infection and is more apt to contain fluid collections. 8 Consequently, aggressive surgical interventions may be unnecessary in this population. Indeed, the mortality rates and time to oral feeding are nearly equal among children treated surgically and those treated conservatively.…”

“…Surgical drainage with or without primary closure has been the primary modality in adults and children, with esophageal resection and enteral diversion procedures reserved for large defects or widely contaminated wounds 5,6 . However, nonoperative management has also proven successful in selected cases, particularly in children 6–9 . Altorjay et al 6 reported their experience with nonoperative therapy (defined by this group as a combination of broad spectrum antibiotics, strict nothing per oral status, and parenteral hyperalimentation) for esophageal perforations.…”

“…They recommend that it be considered in patients with a well‐circumscribed extravasation of esophageal contents, a persistent drainage pathway to and from the esophagus, a tissue defect that is not found within neoplastic tissue or within the abdominal cavity, and the absence of septicemia. Furthermore, it has been suggested that the mediastinum of children is relatively resistant to infection and is more apt to contain fluid collections 8 . Consequently, aggressive surgical interventions may be unnecessary in this population.…”

Pitfalls of gastric intubation in premature infants

“…There is consensus that nearly all pharyngeal and most tuberelated oesophageal injuries can be safely managed nonoperatively. [1][2][3][6][7][8] Appropriate respiratory support and antibiotics should be provided. Infants with pharyngeal injuries and mucosal perforations of the oesophagus can be safely fed through the NGT once appropriately placed, but resumption of oral feeding should be delayed until the radiological 'leak' has resolved.…”