During a 25-year period between 1971 and 1996, 195 patients with
caustic esophageal
strictures underwent repeated dilations program and 34 had 36 complicating perforations (17.4%) at the Hacettepe Children's Hospital Department of Pediatric Surgery. A retrospective clinical study was performed to evaluate the risks, results and outcome of
esophageal perforations encountered among strictured esophaguses. Thirty-four patients, of whom 19 were male (56%) and 15 female (44%) with 25 (74%) being younger than 5 years of age, were evaluated retrospectively.
RESULTS: There was no relation between the type of
therapy against
stricture formation and perforation of the esophagus. Seventy-five percent of perforations occurred during antegrade dilations with stiff woven dilator and most perforations (69.4%) occurred in the first, second or third dilations.
Esophageal perforation was suspected during dilation procedure in 7 perforations while the remaining 29 were diagnosed following a suggestive
clinical course. The diagnosis of perforation was confirmed by chest X-ray, esophagography, and esophagoscopy in 30, 5, and 1 perforations respectively. The treatments included
antibiotics,
digoxin and drainage through
gastrostomy among 13 patients, and additionally
chest tube drainage among 12 patients, and additionally feeding
jejunostomy among 7 patients while three patients underwent only feeding
jejunostomy in addition to
antibiotics,
digoxin and drainage through
gastrostomy. Six patients (18%) died, 6 patients (18%) required esophageal replacement for previous
cervical esophagostomy or persisting
stricture that impairs swallowing. Esophageal
strictures in 22 patients (64%) have been treated by dilations. Redilation
therapy started within 3 months following perforation and 68% of patients required 2 to 3 years of chronic dilations to be accepted as normal swallowers.
CONCLUSIONS: