Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

Balumuka, Deo D; Chalya, Phillipo L; Mahalu, William

doi:10.1186/1749-8090-6-116

Cited by 5 publications

(5 citation statements)

References 8 publications

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“…[ 3 4 ] There have been reports of higher complications in academic training/teaching institute, emergency procedure, and institute with low patient volume. [ 2 3 5 ] Though instrumentation is the common cause of esophageal injury, sharp object impaction or retrieval (33%) has the highest complication rate which has been reconfirmed in our series also. [ 1 4 ] Site of perforation may be anywhere from cervical to abdominal esophagus.…”

Section: Discussionsupporting

confidence: 71%

“…Five children with corrosive strictures presented within 3 weeks of ingestion while the remaining two had ingested more than 3 months back. Contrast study and endoscopy revealed single (4) or multiple strictures (3); varied size (5 mm in 2 , 1 cm 2 , 1.5 cm 1 , 5 cm 1 ), and site (cricopharynx 2 , middle one-third 2 , lower one-third 5 ) and near complete obstruction (2). Children with severe stricture (2) had gastrostomy, followed by retrograde and ante grade dilatation under endoscopic guidance by the gastroenterologist.…”

Section: Resultsmentioning

confidence: 99%

“…[ 1 4 ] Site of perforation may be anywhere from cervical to abdominal esophagus. [ 5 ] Esophageal strictures are of varied etiology like corrosive poisoning, anastomotic stricture of esophageal atresia repair or replacement tubes. [ 6 7 ]…”

Section: Discussionmentioning

confidence: 99%

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Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Ramareddy

Alladi

2016

J Indian Assoc Pediatr Surg

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Aim:To review the patients with esophageal injuries and stenosis with respect to their etiology, clinical course, management, and the lessons learnt from these.Materials and Methods:Retrospective descriptive observation review of children with esophageal injuries and stenosis admitted between January 2009 and April 2015.Results:Eighteen children with esophageal injuries of varied etiology were managed and included, seven with corrosive injury, five with perforation due to various causes, three with mucosal erosion, two with trachea esophageal fistula (TEF), and one wall erosion. The five children who had perforation were due to poststricture dilatation in a child with esophageal atresia and secondary to foreign body impaction or its attempted retrieval in four. Alkaline button cell had caused TEF in two. Three congenital esophageal stenosis (CES) had presented with dysphagia and respiratory tract infection. Six corrosive stricture and two CES responded to dilatation alone and one each of them required surgery. Four of the children with esophageal perforation were detected early and required drainage procedure (1), diversion (1), and medical management (2). Pseudo diverticulum was managed expectantly. Among TEF, one had spontaneous closure and other one was lost to follow-up. All the remaining nineteen children have recovered well except one CES had mortality.Conclusion:Esophageal injuries though rare can be potentially devastating and life-threatening.

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Section: Discussionsupporting

confidence: 71%

Section: Resultsmentioning

confidence: 99%

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Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Ramareddy

Alladi

2016

J Indian Assoc Pediatr Surg

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“…In case oesophageal rupture is suspected, the best option to confirm it is contrast esophagography [ 12 ]. Diagnosis of oesophageal rupture is not straightforward; it is a big challenge across resource-rich and limited countries [ 13 , 14 ] that do not allow time to be lost. By the time Graffin study was ordered, the patient's condition changed and passed away before the procedure.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting

et al. 2015

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Spontaneous oesophageal rupture after swallowing a bolus of food is a very rare condition. In resource-limited settings, it is very challenging to diagnose this condition especially when its presentation is atypical. Its prognosis is very poor when diagnosis is delayed due to risk of mediastinitis. We report a case of 37-year-old man who was admitted to our hospital complaining of sudden onset of chest tightness and pain after a meal 8 h prior to admission. Urgent chest radiograph revealed right hydropneumothorax with collapsed lung. Water-seal drainage was established gushing 1200 ml of food materials. Definitive diagnosis of oesophageal rupture was reached after post-mortem.

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“…Although the operative management was the most common treatment modality, the current approach to EP treatment in children has shifted towards conservative management [1]. This is especially important in resource limited areas where there is very small number of thoracic pediatric surgeons in addition to the lack facilities [10].…”

Section: Discussionmentioning

confidence: 99%

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

Hamawandi¹,

Baram²,

Ramadhan³

et al. 2014

OJGas

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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.

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Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

Cited by 5 publications

References 8 publications

Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Review of esophageal injuries and stenosis: Lessons learn and current concepts of management

Spontaneous oesophageal rupture: a diagnostic challenge in resource-limited setting

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

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