Our approach to esophageal perforation secondary to dilatation of caustic esophageal stricture in children

Background: This study aims to review our 20-year experience in children with esophageal perforation and develop an algorithm. Methods: The study included 50 patients (32 boys, 18 girls; mean age 4.7 +/- 2.6 years; range 1 to 17 years) with esophageal perforation secondary to dilatation of caustic esophageal stricture which was performed between January 1985 and December 2014 in our department. Patients were evaluated retrospectively according to age, sex, time elapsed from intake of caustic substance until admission, time elapsed from dilatation until the diagnosis of perforation, clinical findings, the location of perforation, and method of treatment. Results: Diagnosis of perforation was confirmed within 24 hours after dilatation in 40 patients and 24 hours after dilatation in 10 patients. The mortality rate was higher in the late diagnosed group (n= 2). Perforations occurred in cervical esophagus in two patients, abdominal esophagus in four patients, and thoracic esophagus in 44 patients. In 21 patients, esophageal perforation healed conservatively and no surgical intervention was required. Of the 29 patients with chest tube, 15 healed with conservative management, while nine were performed thoracotomy with abscess drainage and decortications, and five were performed esophagostomy and gastrostomy. Of the five patients who were performed esophagostomy and gastrostomy, two underwent colon interposition operation and three underwent delayed anastomosis. Conclusion: Esophageal perforation induced by dilatation of caustic esophageal strictures is a serious problem which has to be promptly diagnosed, individualizing the therapeutic approach according to the condition of each patient.